Objective: Crohn’s disease of the pouch is defined as the appearance of Crohn’s disease complications such as fistula or stricture in an ulcerative colitis patient in the postoperative period, who had restorative proctocolectomy with ileal pouch anal anastomosis. The aim of this study is to investigate the long-term prognosis of Crohn’s disease in the pouch patients.
Methods: A total of 1166 records of ulcerative colitis patients were examined, and 57 patients who underwent ileal pouch anal anastomosis were detected. We formed 2 control groups from ileal pouch anal anastomosis patients: patients with pouchitis (n = 12) and asymptomatic patients (control group, n = 17).
Results: Ten out of 28 patients with chronic pouchitis were grouped as Crohn’s disease of the pouch. In this group, there were 6 patients with fistula, including 5 with perianal fistula and 1 with pouch–vagina fistula. In 2 patients, there was also concomitant stricture. Four patients had strictures without perinal fistula. In the perianal fistula group, all patients received tumor necrosis factor-alpha blocker treatment (5 infliximab and 1 adalimumab) combined with azathioprine in 5 of them. In the stricture group, 2 patients received azathioprine, 1 patient received infliximab combined with azathioprine, and 1 patient received infliximab monotherapy. In the fistula group, diverting ileostomy was performed in 3 patients; in only 1 patient, fistula flow stopped. During the follow-up period, none of the Crohn’s disease of the pouch patients were in remission except 1 who had diverting ileostomy. Total remission rate in the pouchitis group was 33% (4/12).
Conclusion: Crohn’s disease of the pouch is not an uncommon clinical entity with a frequency of 20% in the long term follow-up. Despite combined medical treatment, one-third of the patients ended with permanent end ileostomy due to pouch failure.
Cite this article as: Gündoğdu Karaköse T, Eşkazan T, Kepil N, et al. Long-term prognosis of crohn’s disease of the pouch: A singlecenter experience of 17 years. Cerrahpaşa Med J. 2023;47(1):37-42.