Natural history of Crohn’s disease in patients who underwent intentional restorative proctocolectomy with ileal pouch-anal anastomosis

Aliment Pharmacol Ther 31, 745–753

Summary

Background Crohn’s disease is generally considered a relative contraindication for restorative proctocolectomy with ileal pouch anastomosis (IPAA). The natural history of IPAA in these patients has not well been defined.

Aim To evaluate the natural history of IPAA in patients with a well-defined preoperative Crohn’s disease.

Methods All patients from the Pouchitis Clinic who had a preoperative diagnosis of Crohn’s disease were screened and 11 patients met the inclusion criteria. The control group (with a 1:4 ratio) consisted of IPAA patients with a preoperative diagnosis of UC.

Results During the follow-up period of 5.0 years, 7 of 11 (63.6%) with a preoperative diagnosis of Crohn’s disease developed Crohn’s disease of the pouch. Crohn’s disease of the pouch developed 0.2–15 years after ileostomy closure. The remaining four patients with a preoperative diagnosis of Crohn’s disease did not demonstrate signs of Crohn’s disease in 2, 11, 11 and 24 years after pouch surgery, respectively.

Conclusions Post-operative development of Crohn’s disease of the pouch was common in patients with a preoperative diagnosis of Crohn’s disease who underwent IPAA. Long-term medical therapy was often required. Large multi-centre studies are warranted to delineate further the natural history of the disease, before Crohn’s disease is considered an indication for IPAA.