{"doi":"10.1093/ecco-jcc/jjaa251","title":"Pre-pouch Ileitis is Associated with Development of Crohn’s Disease-like Complications and Pouch Failure","abstract":"BACKGROUND AND AIMS: It is unclear whether pre-pouch ileitis heralds an aggressive inflammatory pouch disease in patients with ileal pouch-anal anastomosis [IPAA]. We compared outcomes of patients with pouchitis and concomitant pre-pouch ileitis with those with pouchitis alone. METHODS: Patients undergoing IPAA surgery for inflammatory bowel disease, who subsequently developed pouchitis with concomitant pre-pouch ileitis [pre-pouch ileitis group], were matched by year of IPAA surgery and preoperative diagnosis [ulcerative colitis or inflammatory bowel disease-unclassified] with patients who developed pouchitis alone [pouchitis group]. Primary outcomes were development of Crohn's disease [CD]-like complications [non-anastomotic strictures or perianal disease >6 months after ileostomy closure] and pouch failure. Secondary outcomes were need for surgical/endoscopic interventions and immunosuppressive therapy. Log-rank testing was used to compare outcome-free survival, and Cox regression was performed to identify predictors of outcomes. RESULTS: There were 66 patients in each group. CD-like complications and pouch failure developed in 36.4% and 7.6% patients in the pre-pouch ileitis group and 10.6% and 1.5% in pouchitis group, respectively. CD-like complications-free survival [log-rank p = 0.0002] and pouch failure-free survival [log-rank p = 0.046] were significantly lower in the pre-pouch ileitis group. The pre-pouch ileitis group had a higher risk of requiring surgical/endoscopic interventions [log-rank p = 0.0005] and immunosuppressive therapy [log-rank p <0.0001]. Pre-pouch ileitis was independently associated with an increased risk of CD-like complications (hazard ratio [HR] 3.8; p = 0.0007), need for surgical/endoscopic interventions [HR 4.1; p = 0.002], and immunosuppressive therapy [HR 5.0; p = 0.0002]. CONCLUSIONS: Pre-pouch ileitis is associated with a higher risk of complicated disease and pouch failure than pouchitis. It should be considered a feature of CD.","journal":"Journal of Crohn s and Colitis","year":2020,"id":75823,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":23,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9679,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":396531,"name":"Ron Shemtov","orcid":null,"position":1,"is_corresponding":false},{"id":235535,"name":"Nirupama Bonthala","orcid":"0000-0001-7511-2291","position":2,"is_corresponding":false},{"id":396532,"name":"Eric A. Vasiliauskas","orcid":null,"position":3,"is_corresponding":false},{"id":396533,"name":"Edward J. Feldman","orcid":null,"position":4,"is_corresponding":false},{"id":395672,"name":"Karen Zaghiyan","orcid":"0000-0003-4142-913X","position":5,"is_corresponding":false},{"id":277912,"name":"Christina Ha","orcid":"0000-0003-3897-7370","position":6,"is_corresponding":false},{"id":1090,"name":"Dermot McGovern","orcid":"0000-0001-5621-759X","position":7,"is_corresponding":false},{"id":339307,"name":"Stephan R. Targan","orcid":"0000-0003-0265-5193","position":8,"is_corresponding":false},{"id":395673,"name":"Gil Melmed","orcid":"0000-0002-2591-5165","position":9,"is_corresponding":false},{"id":343614,"name":"Phillip Fleshner","orcid":null,"position":10,"is_corresponding":false},{"id":277914,"name":"Gaurav Syal","orcid":"0000-0002-5803-5877","position":0,"is_corresponding":true}],"reference_count":23,"raw_metadata":null,"created_at":"2026-07-18T21:46:55.856612Z","pmid":"33300546","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}