Rinawi F, et al. – Physicians designed this study to ascertain clinical predictors for the development of pouchitis following ileal pouch–anal anastomosis (IPAA) in pediatric-onset ulcerative colitis patients. In pediatric–onset ulcerative colitis (UC) after IPAA, long–term risk for pouchitis was significantly high. Vitamin–D deficiency and younger age at colectomy could increase the risk for pouchitis.

• Between 1981 and 2013, the physicians conducted a retrospective chart review of all pediatric UC cases that were diagnosed at the Schneider Children’s Medical Center of Israel and who underwent colectomy during disease course.
• They evaluated potential predictors for pouchitis and chronic pouchitis including various demographic, clinical, endoscopic, and histological variables at diagnosis and at the time of surgery.

• In this study, 33 patients (18%) underwent colectomy and IPAA surgery among 188 patients with pediatric-onset UC.
• 20 out of 33 (60%) patients developed pouchitis including 11 out of 33 (33%) patients who developed chronic pouchitis during a median postsurgical follow-up of 7.6 (range: 1-21.5) years following IPAA.
• At 1 year, Kaplan-Meier survival estimates of the cumulative probability for pouchitis were 9% and 36 and 55% at 5 and 10 years, respectively.
• Multivariate Cox models demonstrated that older age at colectomy (hazard ratio: 0.86, P=0.024) was a protective factor, while preoperative vitamin-D deficiency (≤20 ng/ml) (hazard ratio: 4.4, P=0.021) increased the risk for pouchitis.
• Factors did not affect the risk of pouchitis were age at diagnosis, sex, disease extent, and preoperative therapeutic regimens.