Risk factors for diseases of heal pouch-anal anastomosis after restorative proctocolectomy for ulcerative colitis
Risk factors for diseases of heal pouch-anal anastomosis after restorative proctocolectomy for ulcerative colitis
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DOI：
10.1016/j.cgh.2005.10.004
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发表时间：
2006-01-01
影响因子：
12.6
通讯作者：
Lashner, BA
中科院分区：
文献类型：
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作者：
Shen, B;Fazio, VW;Lashner, BA
背景与目的：虽然袋炎被认为是回肠袋-肛门吻合术（IPAA）最常见的不良后遗症，但除袋炎外的炎症和非炎症性疾病也越来越被认识到。这些非眼袋炎的危险因素，包括眼袋的克罗恩病（CD）、眼袋炎和眼袋易激综合征（IPS），尚未被研究。本研究的目的是评估三级医疗机构中炎症性和非炎症性IPAA疾病的危险因素。方法：该研究包括240例连续患者，分为健康眼袋（49例）、眼袋炎（61例）、眼袋CD（39例）、眼袋炎（41例）和IPS（50例）。通过使用逻辑回归分析评估人口统计学和临床特征，以确定每种情况的危险因素。结果：最终logistic回归模型中剩余的危险因素为：包囊炎：IPAA指状发育不良（优势比[OR]， 3.89； 95%可信区间[CI]， 1.69-8.98），从未吸烟（OR, 5.09; 95% CI, 1.01-25.69），未使用抗焦虑药物（OR, 5.19; 95% CI, 1.45-18.59），或使用非甾体抗炎药（OR, 3.24; 95% CI, 1.71-6.13）；对于眼袋CD：长期服用IPAA （OR, 1.20; 95% CI, 1.12-1.30）和当前吸烟（OR, 4.77; 95% CI, 1.39-16.25）；对于袖炎：关节痛（OR, 4.13; 95% CI, 1.91-8.94）和年龄更小（OR, 1.16; 95% CI, 1.01-1.33）；对于IPS：使用抗抑郁药（OR, 4.17, 95% CI, 1.95-8.92）或抗焦虑药（OR, 3.21; 95% CI, 1.34-7.47）。结论：IPAA的4种炎症性和非炎症性疾病的大多数危险因素不同，提示每种疾病具有不同的病因和发病机制。这些危险因素的识别和修改有助于患者和临床医生对IPAA进行术前决策，减少IPAA相关的发病率，提高对治疗的反应。
Background & Aims: Although pouchitis is considered the most common adverse sequela of ileal pouch-anal anastomosis (IPAA), inflammatory and noninflammatory conditions other than pouchitis are increasingly being recognized. The risk factors for these non-pouchitis conditions, including Crohn's disease (CD) of the pouch, cuffitis, and irritable pouch syndrome (IPS), have not been studied. The aim of this study was to assess risk factors for inflammatory and noninflammatory diseases of IPAA in a tertiary care setting. Methods: The study consisted of 240 consecutive patients who were classified as having healthy pouches (N = 49), pouchitis (N = 61), CD of the pouch (N = 39), cuffitis (N = 41), or IPS (N = 50). Demographic and clinical features were assessed to determine risk factors for each of these conditions by using logistic regression analysis. Results: Risk factors remaining in the final logistic regression models were for pouchitis: IPAA indication for dysplasia (odds ratio [OR], 3.89; 95% confidence interval [CI], 1.69-8.98), never having smoked (OR, 5.09; 95% CI, 1.01-25.69), no use of anti-anxiety agents (OR, 5.19; 95% CI, 1.45-18.59), or use of NSAIDs (OR, 3.24; 95% CI, 1.71-6.13); for CD of the pouch: a long duration of IPAA (OR, 1.20; 95% CI, 1.12-1.30) and current smoking (OR, 4.77; 95% CI, 1.39-16.25); for cuffitis: arthralgias (OR, 4.13; 95% CI, 1.91-8.94) and younger age (OR, 1.16; 95% CI, 1.01-1.33); and for IPS: use of antidepressants (OR, 4.17, 95% CI, 1.95-8.92) or anti-anxiety agents (OR, 3.21; 95% CI, 1.34-7.47). Conclusions: The majority of risk factors for the 4 inflammatory and noninflammatory conditions of IPAA are different, suggesting that each of these diseases has a different etiology and pathogenesis. The identification and modification of these risk factors might help patients and clinicians to make a preoperative decision for IPAA, reduce IPAA-related morbidity, and improve response to treatment.