Prior antibiotic use ups pouchitis risk after ileal pouch-anal anastomosis

Antibiotic exposure may put individuals scheduled to undergo ileal pouch-anal anastomosis (IPAA) at increased risk of pouchitis, according to a study.

For the study, researchers established a population-based cohort involving adults residing in Denmark who were undergoing proctocolectomy with IPAA for ulcerative colitis. A total of 1,616 individuals were identified and included in the analysis.

Cox proportional hazard analysis was conducted to evaluate the effect of exposure to antibiotics or nonsteroidal anti-inflammatory drugs (NSAIDs) and appendectomy on the incidence of acute pouchitis in the first 2 years after IPAA surgery. Factors such as antitumour necrosis factor alpha use and sex were included in the analysis as potential confounders.

Over 2 years after IPAA, pouchitis occurred in 46 percent of patients. The risk of pouchitis was 40-percent higher among patients with antibiotic exposure in the 12 months prior to IPAA (adjusted hazard ratio [aHR], 1.41, 95 percent confidence interval [CI], 1.22–1.64).

Of note, the risk increase was commensurate with the number of antibiotic treatment courses. Compared with the absence of antibiotic prescriptions in the 12 months prior to IPAA, being exposed to three or more courses of antibiotics in that period was associated with a higher risk of pouchitis (aHR, 1.77, 95 percent CI, 1.41–2.21) than being exposed to one or two courses (aHR, 1.30, 95 percent CI, 1.11–1.52).

Meanwhile, neither NSAID exposure in the 12 months prior to IPAA nor appendectomy showed an association with the risk of acute pouchitis (p=0.201 and p=0.865, respectively).

More prospective studies are needed to identify specific microbial changes in at-risk patients and develop early interventions.