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

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.