Background: Pouchitis is the most frequent complication after ileal pouch–anal anastomosis for refractory ulcerative colitis. A non-standardized preventative treatment exists. Sulfasalazine has proved effective in acute pouchitis therapy. Aims: The aim of this study was to retrospectively evaluate the effect of sulfasalazine in primary prophylaxis of pouchitis after proctocolectomy with ileal pouch–anal anastomosis. Methods: Data files of patients who underwent total proctocolectomy with ileal pouch–anal anastomosis for refractory ulcerative colitis and/or dysplasia from January 2007 to December 2014, with a follow-up until August 2015, were analyzed. After closure of loop ileostomy, on a voluntary basis, patients received a primary prophylaxis of pouchitis with sulfasalazine (2000 mg per day) continually until acute pouchitis flare and/or drop out due to side effects. Results: Follow-up data were available for 51 of the 55 surgical patients. Median follow-up time was 68 months (range 10–104). Thirty postoperative complications occurred in 25 patients. 45% of patients developed pouchitis. Sulfasalazine prophylaxis was administered in 39.2% of patients; 15% of the these developed pouchitis versus 64.5% (20/31) of the non-sulfasalazine patients (p < 0.001). Pouchitis-free survival curves were 90.55 months in sulfasalazine patients and 44.46 in non-sulfasalazine patients (log-rank test p = 0.001, Breslow p = 0.001). Conclusion: Sulfasalazine may be potentially administered in pouchitis prophylaxis after proctocolectomy with ileal pouch–anal anastomosis, but large prospectively controlled trials are needed.

Sulfasalazine in Prevention of Pouchitis After Proctocolectomy with Ileal Pouch–Anal Anastomosis for Ulcerative Colitis

SCAIOLI, ELEONORA;SARTINI, ALESSANDRO;LIVERANI, ELISA;UGOLINI, GIAMPAOLO;ROSATI, GIANCARLO;POGGIOLI, GILBERTO;FESTI, DAVIDE;BAZZOLI, FRANCO;BELLUZZI, ANDREA
2017

Abstract

Background: Pouchitis is the most frequent complication after ileal pouch–anal anastomosis for refractory ulcerative colitis. A non-standardized preventative treatment exists. Sulfasalazine has proved effective in acute pouchitis therapy. Aims: The aim of this study was to retrospectively evaluate the effect of sulfasalazine in primary prophylaxis of pouchitis after proctocolectomy with ileal pouch–anal anastomosis. Methods: Data files of patients who underwent total proctocolectomy with ileal pouch–anal anastomosis for refractory ulcerative colitis and/or dysplasia from January 2007 to December 2014, with a follow-up until August 2015, were analyzed. After closure of loop ileostomy, on a voluntary basis, patients received a primary prophylaxis of pouchitis with sulfasalazine (2000 mg per day) continually until acute pouchitis flare and/or drop out due to side effects. Results: Follow-up data were available for 51 of the 55 surgical patients. Median follow-up time was 68 months (range 10–104). Thirty postoperative complications occurred in 25 patients. 45% of patients developed pouchitis. Sulfasalazine prophylaxis was administered in 39.2% of patients; 15% of the these developed pouchitis versus 64.5% (20/31) of the non-sulfasalazine patients (p < 0.001). Pouchitis-free survival curves were 90.55 months in sulfasalazine patients and 44.46 in non-sulfasalazine patients (log-rank test p = 0.001, Breslow p = 0.001). Conclusion: Sulfasalazine may be potentially administered in pouchitis prophylaxis after proctocolectomy with ileal pouch–anal anastomosis, but large prospectively controlled trials are needed.
Scaioli, Eleonora; Sartini, Alessandro; Liverani, Elisa; Digby, Richard John; Ugolini, Giampaolo; Rosati, Giancarlo; Poggioli, Gilberto; Festi, Davide; Bazzoli, Franco; Belluzzi, Andrea
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11585/588647
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