Primary Sclerosing Cholangitis and Extraintestinal Manifestations in Patients with Ulcerative Colitis and Ileal Pouch–Anal Anastomosis

• Published in: Journal of gastrointestinal surgery Vol. 14; no. 7; pp. 1099 - 1104
• Main Authors: Wasmuth, Hans H., Tranø, Gerd, Endreseth, Birger H., Wibe, Arne, Rydning, Astrid, Myrvold, Helge E.
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.07.2010; Springer Nature B.V
• Subjects: Adult; Arthritis - etiology; Athletes; Cancer; Cholangitis, Sclerosing - complications; Colitis, Ulcerative - surgery; Colonic Neoplasms - etiology; Female; Gastroenterology; Humans; Inflammatory bowel disease; Male; Medicine; Medicine & Public Health; Original Article; Postoperative Complications; Pouchitis - etiology; Proctocolectomy, Restorative; Pyoderma Gangrenosum - etiology; Risk Management; Spondylitis, Ankylosing - etiology; Surgery; Treatment Outcome; Pouchitis; Primary sclerosing cholangitis; Extraintestinal manifestations; Ileal pouch–anal anastomosis; Ulcerative colitis
• ISSN: 1091-255X; 1873-4626
• DOI: 10.1007/s11605-010-1223-x

Objective The aim of this study was to assess complications and functional outcomes in patients having ileal pouch–anal anastomosis for ulcerative colitis with or without primary sclerosing cholangitis or extraintestinal manifestations and to assess if primary sclerosing cholangitis is a risk factor for pouchitis. Materials and methods From 1984 to 2007, 289 patients underwent proctocolectomy with ileal pouch–anal anastomosis for ulcerative colitis. Mean follow-up time was 12 years and data was recorded prospectively. Eleven patients had primary sclerosing cholangitis, six had pyoderma gangrenosum, and 12 had arthritis or ankylosing spondylitis. Results Early complications were similar for patients with or without extraintestinal manifestations. Functional outcomes were similar, but more incontinence among patients with sclerosing cholangitis was found. These patients had more frequent pouchitis, 5.25 vs. 2.72 average episodes of pouchitis ( p  = 0.048), and more chronic pouchitis, 4/11 vs. 17/260 ( p  < 0.001) compared to patients without adjunct disease. Neoplasm of the colon was more frequent in patients with primary sclerosing cholangitis, 4/11 vs. 4/260 in ulcerative colitis patients ( p  < 0.001). Conclusion An association between primary sclerosing cholangitis and chronic/severe pouchitis was found, but not with other extraintestinal manifestations. Functional results were good and alike in patients with and without primary sclerosing cholangitis. Primary sclerosing cholangitis is a risk factor for chronic pouchitis and is associated with neoplasia.