Skip to main content

Advertisement

SpringerLink
Log in

Association Between Portal Vein Thrombosis and Pouchitis in Patients with Ulcerative Colitis

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background

Pouchitis is the most common long-term complication in patients requiring colectomy ileal pouch-anal anastomosis with medically refractory ulcerative colitis or colitis-associated neoplasia. A previous small case series suggests associated between portal vein thrombosis (PVT) and ischemic pouchitis.

Aim

To evaluate the association between PVT and other demographic and clinical factors and pouchitis.

Methods

We used Explorys Inc., a population-based database, to search medical records between 1999 and 2020 with SNOMED-CT code criteria for “construction of pouch” and “ileal pouchitis.” Patients with pouchitis were compared to those with previous pouch construction without pouchitis. Factors associated with pouchitis identified with univariable analysis were introduced into a multivariable model. A post hoc analysis further stratified demographical findings of the association between PVT and pouchitis.

Results

We identified 7900 patients with ileal pouchitis (7.5%) and 97,510 with pouch construction without pouchitis. In multivariate binary logistic regression, adjusted odds ratio (aOR) for the risk of pouchitis in patients with PVT was 10.78 (95% confidence interval [CI] 7.04–16.49, P < 0.001). Other significant factors associated with pouchitis included male gender (aOR 1.11, 95% CI 1.02–1.21, P = 0.018), deep vein thrombosis (aOR 1.46, 95% CI 1.23–1.72, P < 0.001), and the use of non-steroidal anti-inflammatory drugs (aOR 1.37, 95% CI 1.28–1.45, P < 0.001). Smoking was a protective factor (aOR 0.30, 95% CI 0.33–0.36, P < 0.001). Further sub-analysis showed a higher prevalence of younger patients with PVT and pouchitis.

Conclusions

We report PVT as an independent risk factor associated with pouchitis. Our findings support that PVT is a potentially manageable perioperative complication, and intervention may reduce the risk of pouchitis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Shen B. Pouchitis: what every gastroenterologist needs to know. Clin Gastroenterol Hepatol. 2013;11:1538–1549.

    Article  Google Scholar 

  2. Brunel M, Penna C, Tiret E, Balladur P, Parc R. Restorative proctocolectomy for distal ulcerative colitis. Gut. 1999;45:542–545.

    Article  CAS  Google Scholar 

  3. Penna C, Dozois R, Tremaine W et al. Pouchitis after ileal pouch-anal anastomosis for ulcerative colitis occurs with increased frequency in patients with associated primary sclerosing cholangitis. Gut. 1996;38:234–239.

    Article  CAS  Google Scholar 

  4. Fazio VW, Ziv Y, Church JM et al. Ileal pouch-anal anastomoses complications and function in 1005 patients. Ann Surg. 1995;222:120–127.

    Article  CAS  Google Scholar 

  5. Ferrante M, Declerck S, De Hertogh G et al. Outcome after proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis. Inflamm Bowel Dis. 2008;14:20–28.

    Article  Google Scholar 

  6. Fleshner P, Ippoliti A, Dubinsky M et al. Both Preoperative Perinuclear Antineutrophil Cytoplasmic Antibody and Anti-CBir1 Expression in ulcerative colitis patients influence pouchitis development after ileal pouch-anal anastomosis. Clin Gastroenterol Hepatol. 2008;6:561–568.

    Article  Google Scholar 

  7. Gionchetti P, Rizzello F, Helwig U et al. Prophylaxis of pouchitis onset with probiotic therapy: a double-blind, placebo-controlled trial. Gastroenterology. 2003;124:1202–1209.

    Article  Google Scholar 

  8. Simchuk EJ, Thirlby RC. Risk factors and true incidence of pouchitis in patients after ileal pouch—anal anastomoses. World J Surg. 2000;24:851–856.

    Article  CAS  Google Scholar 

  9. Schieffer KM, Williams ED, Yochum GS, Walter A, Surgery R. Review article: the pathogenesis of pouchitis. Aliment Pharmacol Ther. 2016;44:817–835.

    Article  CAS  Google Scholar 

  10. Shen B, Jiang ZD, Fazio VW et al. Clostridium difficile infection in patients with ileal pouch-anal anastomosis. Clin Gastroenterol Hepatol. 2008;6:782–788.

    Article  CAS  Google Scholar 

  11. Haneda S, Watanabe MDK, Takahashi MDK, Funayama Y, Sasaki MDI. The long-term clinical course of pouchitis after total proctocolectomy and IPAA for ulcerative colitis. Dis Colon Rectum. 2012;3:330–336.

    Google Scholar 

  12. Lohmuller JL, Pemberton JH, Dozois RR. Pouchitis and extraintestinal manifestations of inflammatory bowel disease after iheal pouch-anal anastomosis. Ann Surg. 1990;211:622–629.

    CAS  PubMed  PubMed Central  Google Scholar 

  13. Fleshner P, Ippoliti A, Dubinsky M et al. A prospective multivariate analysis of clinical factors associated with pouchitis after ileal pouch-anal anastomosis. Clin Gastroenterol Hepatol. 2007;5:952–958.

    Article  Google Scholar 

  14. Shen B, Plesec TP, Remer E et al. Asymmetric endoscopic inflammation of the ileal pouch: a sign of ischemic pouchitis? Inflamm Bowel Dis. 2010;16:836–846.

    Article  Google Scholar 

  15. A Wealth of Clinical Information in a Living Data Set Efficient Generation of Real-World Data for Health Informatics; 2017. http://www.ibm.com/watson/health/explorys/. Accessed December 19, 2019.

  16. Hill E, Abboud H, Briggs FBS. Prevalence of asthma in multiple sclerosis: a United States population-based study. Mult Scler Relat Disord. 2019;28:69–74.

    Article  CAS  Google Scholar 

  17. Kaelber DC, Foster W, Gilder J, Love TE, Jain AK. Patient characteristics associated with venous thromboembolic events: a cohort study using pooled electronic health record data. J Am Med Inform Assoc. 2012;19:965–972.

    Article  Google Scholar 

  18. Sheriff MZ, Mansoor E, Luther J et al. Opportunistic infections are more prevalent in Crohn’s disease and ulcerative colitis: a large population-based study. Inflamm Bowel Dis. 2020;26:291–300.

    Article  Google Scholar 

  19. Syed A, Maradey-Romero C, Fass R. The relationship between eosinophilic esophagitis and esophageal cancer. Dis Esophagus. 2017;30:1–5.

    Article  CAS  Google Scholar 

  20. Syed AR, Thakkar P, Horne ZD et al. Old vs new: risk factors predicting early-onset colorectal cancer. World J Gastrointest Oncol. 2019;11:1011–1020.

    Article  Google Scholar 

  21. Syed A, Babich O, Thakkar P et al. Defining pancreatitis as a risk factor for pancreatic cancer: the role, incidence, and timeline of development. Pancreas. 2019;48:1098–1101.

    Article  CAS  Google Scholar 

  22. Nadkarni PM, Darer JA. Migrating existing clinical content from ICD-9 to SNOMED. J Am Med Inform Assoc. 2010;17:602–607.

    Article  Google Scholar 

  23. Hata K, Ishihara S, Nozawa H et al. Pouchitis after ileal pouch-anal anastomosis in ulcerative colitis: diagnosis, management, risk factors, and incidence. Dig Endosc. 2017;29:26–34.

    Article  Google Scholar 

  24. Gorrepati V, Stuart A, Deiling S, Koltun W, Tinsley A, Williams E. Smoking and the risk of pouchitis in ulcerative colitis patients with ileal pouch-anal anastomosis. Inflamm Bowel Dis. 2018;24:2027–2032.

    Article  Google Scholar 

  25. Remzi FH, Fazio VW, Oncel M et al. Portal vein thrombi after restorative proctocolectomy. Surgery. 2002;132:655–662.

    Article  Google Scholar 

  26. Ball CG, MacLean AR, Buie WD, Smith DF, Raber EL. Portal vein thrombi after ileal pouch-anal anastomosis: its incidence and association with pouchitis. Surg Today. 2007;37:552–557.

    Article  Google Scholar 

  27. Millan M, Hull TL, Hammel J, Remzi F. Portal vein thrombi after restorative proctocolectomy: serious complication without long-term sequelae. Dis Colon Rectum. 2007;50:1540–1544.

    Article  CAS  Google Scholar 

  28. To N, Ford AC, Gracie DJ. Systematic review with meta-analysis: the effect of tobacco smoking on the natural history of ulcerative colitis. Aliment Pharmacol Ther. 2016;44:117–126.

    Article  CAS  Google Scholar 

  29. Shen B, Fazio VW, Remzi FH et al. Risk factors for diseases of ileal pouch-anal anastomosis after restorative proctocolectomy for ulcerative colitis. Clin. Gastroenterol. Hepatol. 2006;4:81–89.

    Article  Google Scholar 

  30. Lewin S, McConnell R, Patel R, Sharpton S, Velayos F, Mahadevan U. Improving the quality of inpatient ulcerative colitis management: Promoting evidence-based practice and reducing care variation with an inpatient protocol. Inflamm Bowel Dis. 2019;25:1822–1827.

    Article  Google Scholar 

  31. Merrett MN, Mortensen N, Kettlewell M, Jewell DO. Smoking may prevent pouchitis in patients with restorative proctocolectomy for ulcerative colitis. Gut. 1996;38:362–364.

    Article  CAS  Google Scholar 

  32. Arora Z, Wu X, Navaneethan U, Shen B. Non-surgical porto-mesenteric vein thrombosis is associated with worse long-term outcomes in inflammatory bowel diseases. Gastroenterol. 2016;4:210–215.

    Google Scholar 

  33. Meshikhes AWN, Al-Ghazal T. Portal vein thrombosis after restorative proctocolectomy for familial adenomatous polyposis and sigmoid cancer. Case Rep Gastroenterol. 2012;6:124–130.

    Article  Google Scholar 

  34. Szeto W, Farraye FA. Incidence, prevalence, and risk factors for pouchitis. Semin Colon Rectal Surg. 2017;28:116–120.

    Article  Google Scholar 

Download references

Acknowledgments

Dr. Bo Shen is supported by the Edelman-Jarislawski Professorship who is also thankful for Mr. and Mrs. Quint for their generous support of the Ileal Pouch Program at Columbia University Irving Medical Center.

Funding

This study had no financial support or assistance.

Author information

Authors and Affiliations

  1. Division of Gastroenterology, Allegheny Health Network, Pittsburgh, PA, USA

    Aslam Syed

  2. Department of Medicine, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA

    Aslam Syed

  3. Division of Gastroenterology and Hepatology, Stony Brook University Hospital, Long Island, NY, USA

    Talal Seoud

  4. Medical Scientist Training Program, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Neil M. Carleton

  5. Adjunct Faculty, Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA

    Shyam Thakkar

  6. Center for Inflammatory Bowel Disease, Columbia University Irving Medical Center/New York Presbyterian Hospital, Herbert Irving Pavilion-Rm 843, 161 Fort Washington Ave, New York, NY, 10032, USA

    Ravi P. Kiran & Bo Shen

Authors
  1. Aslam Syed
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Talal Seoud
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Neil M. Carleton
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shyam Thakkar
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ravi P. Kiran
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Bo Shen
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

AS contributed to conception and design, initial data collection and analysis, interpretation of the data, drafting of the article, final approval of the article. TS contributed to initial data collection and analysis, drafting of the article; final approval of the article. NMC contributed to data interpretation and manuscript preparation, critical revisions, final approval of the article. ST contributed to manuscript preparation and critical revisions, final approval of the manuscript. RPK contributed to manuscript preparation and critical revisions, final approval of the manuscript. BS contributed to concept and design, interpretation of the data, manuscript preparation and critical revision of the article for important intellectual content, final approval of the article.

Corresponding author

Correspondence to Bo Shen.

Ethics declarations

Conflict of interest

The authors have financial arrangements related to the research presented in this manuscript.

Ethical and legal considerations

This study is HIPAA and HITECH compliant and only provides de-identified aggregated numerical data, therefore, it is exempt from the Institutional Review Board [17].

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

10620_2021_6969_MOESM1_ESM.docx

SUPPLEMENTARY TABLE 1a. Construction of Pouch SNOMED Clinical Terminology. 1b. Risk Factors Defined by SNOMED Clinical Terminology (DOCX 17 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Syed, A., Seoud, T., Carleton, N.M. et al. Association Between Portal Vein Thrombosis and Pouchitis in Patients with Ulcerative Colitis. Dig Dis Sci 67, 1303–1310 (2022). https://doi.org/10.1007/s10620-021-06969-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-021-06969-5

Keywords

Search

Navigation