Pouchitis is the most common complication after ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC); however, clinical and environmental risk factors for pouchitis remain poorly understood. We explored the relationship between specific clinical factors and the incidence of pouchitis. We established a population-based cohort of all adult persons in Denmark undergoing proctocolectomy with IPAA for UC from 1996–2020. We used Cox proportional hazard modeling to assess the impact of antibiotic, nonsteroidal anti-inflammatory drug (NSAID) exposure, and appendectomy on diagnosis of acute pouchitis in the first 2 years after IPAA surgery. Among 1616 eligible patients, 46% developed pouchitis in the first 2 years after IPAA. Antibiotic exposure in the 12 months before IPAA was associated with an increased risk of pouchitis (adjusted hazard ratio [aHR], 1.41; 95% confidence interval [CI], 1.22–1.64) after adjusting for anti–tumor necrosis factor alpha use and sex. Compared with persons without any antibiotic prescriptions in the 12 months before IPAA, the risk of pouchitis was increased in those with 1 or 2 courses of antibiotics in that period (aHR, 1.30; 95% CI, 1.11–1.52) and 3 or more courses (aHR, 1.77; 95% CI, 1.41–2.21). NSAID exposure in the 12 months before IPAA and appendectomy were not associated with risk of acute pouchitis ( = .201 and = .865, respectively). In this population-based cohort study, we demonstrated that antibiotic exposure in the 12 months before IPAA is associated with an increased risk of acute pouchitis. Future prospective studies may isolate specific microbial changes in at-risk patients to drive earlier interventions.

中文翻译：

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回肠储袋肛门吻合术前 12 个月内使用抗生素会增加储袋炎的风险

储袋炎是溃疡性结肠炎（UC）回肠储袋肛门吻合术（IPAA）后最常见的并发症；然而，对于储袋炎的临床和环境危险因素仍知之甚少。我们探讨了特定临床因素与储袋炎发病率之间的关系。我们建立了一个基于人群的队列，其中包括 1996 年至 2020 年期间接受 IPAA 治疗 UC 的丹麦所有成年人。我们使用 Cox 比例风险模型来评估抗生素、非甾体抗炎药 (NSAID) 暴露和阑尾切除术对 IPAA 手术后头 2 年内急性储袋炎诊断的影响。在 1616 名符合条件的患者中，46% 的患者在 IPAA 后的头 2 年内出现了储袋炎。在调整抗肿瘤坏死因子 α 使用和性别后，IPAA 前 12 个月的抗生素暴露与储袋炎风险增加相关（调整后风险比 [aHR]，1.41；95% 置信区间 [CI]，1.22–1.64） 。与 IPAA 前 12 个月内未开过任何抗生素处方的人相比，在此期间服用 1 或 2 个疗程抗生素的人发生储袋炎的风险增加（aHR，1.30；95% CI，1.11–1.52）和 3 个或更多疗程（aHR，1.77；95% CI，1.41-2.21）。 IPAA 和阑尾切除术前 12 个月内 NSAID 暴露与急性储袋炎风险无关（分别 = .201 和 = .865）。在这项基于人群的队列研究中，我们证明在 IPAA 之前 12 个月内接触抗生素与急性储袋炎的风险增加相关。未来的前瞻性研究可能会分离高危患者的特定微生物变化，以推动早期干预。