Photo Credit: iStock.com/Akarawut Lohacharoenvanich

Extraintestinal manifestations, but not the timing of loop ileostomy closure in ulcerative colitis, impact the risk for endoscopic pouch inflammation.

The timing of loop ileostomy closure after ileal pouch-anal anastomosis did not affect the risk for endoscopic pouch inflammation in patients with ulcerative colitis, according to a study published in Crohn’s & Colitis 360.

“Specifically, delaying ileostomy closure due to patient preference or logistical limitations did not result in the development of endoscopic pouch inflammation, suggesting delays can be safe for this patient population,” Taha Qazi, MD, and colleagues wrote.

The study included 290 patients with ulcerative colitis who underwent ileal pouch-anal anastomosis between 2010 and 2020. Among them, 217 had loop ileostomy closure within 116 days of ileal pouch creation, which was categorized as early closure, and 73 patients had closure more than 180 days later, which was categorized as late closure. The late closure group was further grouped by indication for delay: nonmedical reasons or postoperative complications.

Dr. Qazi and colleagues were interested in differences between the early and later closure groups in the development of endoscopic inflammatory pouch disease, a composite of pouch disease activity index score of 4 or higher, mucosal breaks beyond anastomotic lines, and diffuse pouch inflammation.

“The colonic and enteric cells in the bowels are sustained by the fecal stream, and without the fecal stream, these cells are starved of nutrition,” the researchers explained. “Due to this physiologic process, we chose to study whether delaying the ileostomy closure due to reasons that are not associated with medical complications portends a higher risk of subsequent pouch inflammatory complications.”

Impact of Extraintestinal Manifestations

Dr. Qazi and colleagues found that late closure, either for nonmedical reasons or pouch-related surgical complications, was not associated with development of the composite outcome compared with early closure.

However, extraintestinal manifestations (EIMs), which affected 42.1% of patients, were significantly associated with endoscopic inflammatory pouch disease. Patients who experienced one or more EIMs throughout their disease course had a 67% higher risk for developing the outcome, study results showed.

The higher risk is likely caused by an increased inflammatory state in patients with EIMs, according to Dr. Qazi and colleagues.

“There is an association of EIMs with EIPD [endoscopic inflammatory pouch disease], suggesting the need for a vigilant surveillance strategy in these patients,” the researchers wrote. “Future studies should follow patients for longer durations of time and incorporate additional objective measures of pouch health such as biomarkers to best understand these risks.”