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INTRODUCTION Pouchitis is a complication of total colectomy and ileal pouch-anal anastomosis for ulcerative colitis that can lead to hospitalization. We aimed to assess trends of hospitalization rates and health care utilization in patients with pouchitis from 2010 – 2019. METHODS We performed a retrospective cohort study using the National Inpatient Sample database from 2010 to 2019 of hospitalized patients with a primary discharge diagnosis of pouchitis and a secondary diagnosis of inflammatory bowel disease (IBD), or primary diagnosis of IBD and a secondary diagnosis of pouchitis. We compared baseline characteristics and outcomes of patients admitted from 2010-2014 to 2015-2019. The primary outcome was the rate of hospitalization for pouchitis between the two five-year periods. Secondary outcomes included length of hospital stay (LOS) and total hospitalization charges. We applied discharge weights to generate national estimates. RESULTS A total of 8215 hospitalizations with pouchitis were identified for IBD patients, with 3856 hospitalizations in the 2010 – 14 group and 4359 in the 2015- 19 group. The 2015-2019 group had less females (54.54% vs 46.67%, p =0.002) and increased hospitalization in urban teaching hospitals (71.95% vs 85.67%, p< 0.001) (Table 1). Hospitalizations with a primary diagnosis of pouchitis were lower in the 2015-2019 group (58.91% vs 53.21%, p= 0.024). Over the study period (2010-2019), there was a numeric increase in the pouchitis incidence among hospitalized IBD patients (2.68 in 2010 to 2.87 in 2019 per 1000 discharges, p=0.459), and the number of patients undergoing inpatient pouchoscopy (25.67% in 2010 and 26.55% in 2019, p=0.803). The average inflation-adjusted total hospitalization charges were $12,555 higher in 2019 compared to 2010 (p=0.045). However, there was a decrease in LOS over this period (5.99 days in 2010 to 5.39 in 2019, p=0.182) (Figure 1). DISCUSSION Over the past decade, the overall number of hospitalizations for IBD patients with pouchitis remained stable with a slight numeric increase, but the rate of hospitalization primarily for pouchitis has significantly decreased. Although LOS has numerically decreased, the overall cost of hospitalization has increased for IBD patients with pouchitis. This may be partly due to increased endoscopic evaluation performed during more recent years.

BACKGROUND Total proctocolectomy (TPC) followed by ileal pouch anal anastomosis (IPAA) is the surgery of choice for eligible ulcerative colitis patients who are refractory to medical therapy or develop complications such as adenocarcinoma or dysplasia. Although associated with excellent quality of life, IPAA can lead to complications including chronic antibiotic-refractory pouchitis, anatomical complications, and development of Crohn’s disease. These outcomes remain a clinical challenge. The aim of this study was to evaluate the rate of complications and their treatment following TPC with IPAA to assess for predictors of adverse postoperative outcomes. METHODS This was a single center, retrospective study from January 1,2010 to December 31, 2020. We included patients who underwent TPC with IPAA and reported at least one episode of pouchitis, some of whom also had additional complications. Chronic pouchitis was defined as recurrent episodes of biopsy-proven inflammation or as reported in the patient record based on clinical presentation and responsiveness to treatment. Crohn’s disease of the pouch was defined as pre-pouch ileitis or development of a fistula more than 6 months post-operatively. Data is presented as number of cases and proportions. RESULTS A total of 44 subjects who underwent IPAA (52% female, mean age 46.4 ± 11.3 years) were included. The rate of acute pouchitis was 9%, the rate of chronic pouchitis was 75%. In the chronic pouchitis group, 45% were antibiotic-dependent and 7% were antibiotic-refractory. We found that 70% of subjects required the initiation of medical therapy to treat symptoms of pouchitis, with the majority requiring chronic antibiotics (73%) (Table). A total of 10 subjects (23%) required biologics and 10 subjects (23%) required chronic steroid therapy. Anatomic complications were noted in 23 subjects (52%), the most common being abscess/fistula formation (30%), followed by stricture formation (27%). Anatomic complications appeared more likely to occur when more time had elapsed since the original surgery. 10 subjects (23%) needed repeat surgery and 9 subjects (20%) developed Crohn’s disease of the pouch. CONCLUSIONS In our cohort, we found that nearly two thirds of subjects required medical therapy to treat pouchitis following IPAA including 25% requiring treatment biologic/immunosuppressant therapy. In addition, one quarter required repeat surgery for treatment of complications. Limitations of this study include a tertiary patient population and small sample size. We found a lack of standardized characterization of pouchitis with respect to symptoms and lab abnormalities. In future work, we plan to use this data to develop a prospective, multi-center study to establish a standardized database of patients who underwent IPAA. This will help better understand factors that influence outcomes and guide management.

Background Vedolizumab (VDZ) is an α4β7 integrin monoclonal antibody that is effective for both Crohn’s disease (CD) and ulcerative colitis (UC). There is limited data on how vedolizumab’s gut selective mechanism impacts extraintestinal manifestations (EIM) in inflammatory bowel disease (IBD). Methods A retrospective study of all IBD patients at our institution who received at least 1 dose of VDZ between 1/1/2014 and 8/1/2019 were included. Primary outcome was rate of new or worsening EIMs after initiation of VDZ. Secondary outcomes were factors associated with new or worsening EIMs after VDZ. Continuous variables were analyzed using an unpaired student’s t-test. Categorical variables were analyzed using a chi-square test or Fisher’s exact test. A multivariable logistic regression model was built to identify factors associated with EIMs. The final model was obtained by sequentially subtracting variables and retaining variables that were independently associated with EIMs while controlling for other factors. We also identified factors associated with new or worsening of EIMs after VDZ therapy using Fisher’s exact testing and univariable logistic regression. Results A total of 142 patients were included (53.5% with CD, 41.6% with UC, and 4.9% with indeterminate colitis). The median age was 39 years (range 15–78), and 49.3% were women (Table 1). EIMs were noted in 53.5% (n=76) and included: peripheral arthritis (39.4%), sacroileitis (15.5%), erythema nodosum/pyoderma gangrenosum (9.2%), uveitis (4.9%), and episcleritis (0.7%). Twenty patients had more than one EIM. Significant factors associated with having EIMs included female sex (63.2% with EIM vs 33.3% without, p-value < 0.01), tobacco use (23.7% with EIM vs 6.1% without, p < 0.01), CD (60.5% with EIM vs 45.5% without, p=0.02), and prior biologic agent use (94.7% with EIM vs 74.2% without, p < 0.01). On multivariable analysis, female sex (OR 3.19, 95% CI 1.52–6.72), tobacco use (OR 4.84, 95% CI 1.45–16.23), and prior biologic agent use (OR 4.30, 95% CI 1.30–14.20) were the only significant factors. Of the 76 patients with EIMs, 71.1% (n=54) had stable or improved EIMs after starting VDZ and 28.9% (n=22) had worsening or new EIMs after VDZ. Patients who were on steroids at the time of VDZ induction were more likely to have stable or improved EIMs compared to who did not receive concomitant steroid therapy (OR for worsened EIMs 0.20, 95% CI 0.06–0.63) (Table 2). Prior biologic use and current combination therapy did not significantly predict worsening or new EIMs. Conclusion Female sex, tobacco use, and prior biologic agent use are significantly associated with EIMs of IBD. Post-VDZ, the majority of patients had stable to improved EIMs. Patients on concomitant steroid therapy at the time of VDZ induction were more likely to have improved or stable EIMs compared to patients not on steroids.