Do Preop Antibiotics Raise the Risk for Pouchitis?

A study published in Clinical Gastroenterology and Hepatology revealed a significant association between preoperative antibiotic exposure and an increased risk of acute pouchitis following ileal pouch-anal anastomosis (IPAA) surgery.

Researchers aimed to identify the relationship between specific clinical factors and the incidence of pouchitis. The team established a population-based cohort in Denmark, including all adults who underwent proctocolectomy with IPAA for UC from 1996 to 2020. They used Cox proportional hazard models to evaluate the impact of antibiotic and nonsteroidal anti-inflammatory drug (NSAID) exposure, and appendectomy on the diagnosis of acute pouchitis within the first 2 years after IPAA surgery.

Among 1616 eligible patients, 46% developed pouchitis within the first 2 years post-IPAA. The study found that antibiotic exposure in the 12 months prior to IPAA significantly increased the risk of pouchitis. The adjusted hazard ratio (aHR) for developing pouchitis was 1.41 (95% CI, 1.22–1.64) when adjusting for antitumor necrosis factor alpha use and sex. Specifically, patients with 1 or 2 antibiotic courses had an aHR of 1.30 (95% CI, 1.11–1.52), while those with 3 or more courses had an aHR of 1.77 (95% CI, 1.41–2.21) compared to those with no antibiotic prescriptions. Conversely, NSAID exposure and previous appendectomy were not associated with an increased risk of acute pouchitis (P = .201 and P = .865, respectively).

These findings suggest that future prospective studies should focus on identifying specific microbial changes in at-risk patients to develop earlier and more targeted interventions.

Reference
Barnes EL, Karachalia Sandri A, Herfarth HH, Jess T. Antibiotic use in the 12 months prior to ileal pouch-anal anastomosis increases the risk for pouchitis. Clin Gastroenterol Hepatol. 2024;22(8):1678-1686.e8. doi:10.1016/j.cgh.2024.03.012