SAN DIEGO – Changing the acid content of the gastrointestinal tract may reduce the risk of developing pouchitis following ileal pouch anal anastomosis, based on a review of 85 patients at one U.S. center.
After patients underwent ileal pouch anal anastomosis (IPAA) for ulcerative colitis, those who did not develop pouchitis used a proton pump inhibitor (PPI) or histamine2 (H2) blocker on a daily basis significantly more often than did patients who developed pouchitis during follow-up, Dr. Lisa S. Poritz said at the annual Digestive Disease Week.
Patients who did not develop pouchitis also regularly used an antacid significantly more often than did those with pouchitis during follow-up, but "occasional" use of a PPI or H2 blocker showed no statistically significant association with reduced pouchitis incidence, said Dr. Poritz, a colon and rectal surgeon at Pennsylvania State University, Hershey.
Pouchitis is the most common complication of IPAA, occurring in about half of these patients, and chronic pouchitis develops in 5%-19% of them, Dr. Poritz said. Pouchitis produces urgency, bloody bowel movements, and abdominal pain.
IPAA patients who require chronic antibiotic treatment for pouchitis are the subgroup with the best chance to benefit from daily treatment to stop or neutralize acid secretion, a strategy that would "hopefully get them off chronic antibiotics," she said.
The study reviewed ulcerative colitis patients from the Penn State Familial IBD Registry who had undergone IPAA and had at least 2 subsequent years of follow-up. In all, 45 patients developed no pouchitis, and 40 had pouchitis. The registry data showed no demographic or clinical differences between the two subgroups.
The researchers limited their analysis of acid treatment associations to the subgroup of patients for whom data were available. In all, 15 of 30 patients who had no pouchitis following IPAA and 5 of 35 who developed pouchitis received daily treatment with a PPI or H2 blocker, a statistically significant difference. And 12 of 21 patients with no pouchitis took an antacid more than once a week, compared with 3 of 25 patients who developed pouchitis, also a statistically significant difference.
The analysis showed very similar usage rates among the pouchitis and no-pouchitis subgroups for a variety of other agents that could potentially influence this complication, including probiotics, NSAIDs, fiber supplements, antidiarrheal drugs, and immunosuppressive drugs.
The treatment effects of a PPI or H2 blocker on the incidence of pouchitis may be mediated by changes in fecal flora, but clear evidence for the mechanism of action will require further study, she said.
Dr. Poritz said that she had no disclosures.