Published in:
01-04-2017 | Original Article
Sulfasalazine in Prevention of Pouchitis After Proctocolectomy with Ileal Pouch–Anal Anastomosis for Ulcerative Colitis
Published in: Digestive Diseases and Sciences | Issue 4/2017
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Background
Pouchitis is the most frequent complication after ileal pouch–anal anastomosis for refractory ulcerative colitis. A non-standardized preventative treatment exists. Sulfasalazine has proved effective in acute pouchitis therapy.
Aims
The aim of this study was to retrospectively evaluate the effect of sulfasalazine in primary prophylaxis of pouchitis after proctocolectomy with ileal pouch–anal anastomosis.
Methods
Data files of patients who underwent total proctocolectomy with ileal pouch–anal anastomosis for refractory ulcerative colitis and/or dysplasia from January 2007 to December 2014, with a follow-up until August 2015, were analyzed. After closure of loop ileostomy, on a voluntary basis, patients received a primary prophylaxis of pouchitis with sulfasalazine (2000 mg per day) continually until acute pouchitis flare and/or drop out due to side effects.
Results
Follow-up data were available for 51 of the 55 surgical patients. Median follow-up time was 68 months (range 10–104). Thirty postoperative complications occurred in 25 patients. 45% of patients developed pouchitis. Sulfasalazine prophylaxis was administered in 39.2% of patients; 15% of the these developed pouchitis versus 64.5% (20/31) of the non-sulfasalazine patients (p < 0.001). Pouchitis-free survival curves were 90.55 months in sulfasalazine patients and 44.46 in non-sulfasalazine patients (log-rank test p = 0.001, Breslow p = 0.001).
Conclusion
Sulfasalazine may be potentially administered in pouchitis prophylaxis after proctocolectomy with ileal pouch–anal anastomosis, but large prospectively controlled trials are needed.