Family history of Crohnʼs disease is associated with an increased risk for Crohnʼs disease of the pouch

Abstract

Crohn's disease (CD) of the pouch can occur in patients with restorative proctocolectomy and ileal pouch–anal anastomosis originally performed for a preoperative diagnosis of ulcerative colitis (UC). CD of the pouch was often observed in patients with a family history of CD. The purpose was to determine whether the family history of CD increased the risk for CD of the pouch in patients who underwent restorative proctocolectomy. A total of 558 eligible patients seen in the Pouchitis Clinic were enrolled, including 116 patients with CD of the pouch and 442 patients with a normal pouch or other pouch disorders. Demographic and clinical variables were included in the study. Multivariable logistic regression analyses were performed. The adjusted multivariate logistic analyses revealed that the risk for CD of the pouch was increased in patients with a family history of CD, with an odds ratio (OR) of 3.22 (95% confidence interval [CI] 1.56–6.67), or with a first-degree relative with CD (OR = 4.18, 95% CI, 1.48–11.8), or with a greater number of family members with CD (OR = 2.00 per family member, 95% CI, 1.19–3.37), adjusting for age, gender, smoking status, duration of IBD, duration of having a pouch, and a preoperation diagnosis of indeterminate colitis or CD. In addition, patients of younger age and longer duration of having a pouch had a higher risk for CD of the pouch. A diagnosis of CD of the pouch was associated with a poor outcome, with a greater than 5-fold estimated increased odds of pouch failure (OR = 5.58, 95% CI, 2.74–11.4). The presence of a family history of CD is associated with an increased risk for CD of the pouch, which in turn has a high risk for pouch failure.