Journal Article

Ethnicity and the risk of development of Crohn's disease of the ileal pouch☆, ☆☆

Saurabh Mukewar, Xianrui Wu, Rocio Lopez, Ravi P. Kiran, Feza H. Remzi and Bo Shen

in Journal of Crohn's and Colitis

Volume 7, issue 5, pages e178-e185
Published in print June 2013 | ISSN: 1873-9946
Published online June 2013 | e-ISSN: 1876-4479 | DOI: https://dx.doi.org/10.1016/j.crohns.2012.08.002
Ethnicity and the risk of development of Crohn's disease of the ileal pouch☆, ☆☆

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Abstract

Background: A system-wide, multi-ethnicity study on Crohn's disease (CD) of the pouch, including Indian American (IA) patients has not been conducted.

Aim: To compare the frequency of subsequent development of CD of the pouch for African-American (AA), Hispanic-American (HA), IA and Caucasian patients with ulcerative (UC) undergoing ileal-pouch anal anastomosis (IPAA).

Methods: In this historical cohort study from our Pouch Registry, patients with restorative proctocolectomy and IPAA for IBD with identifiable, self-declared racial background (i.e. AA, HA, IA or Caucasian) were included. Univariable and multivariable analyses were performed to identify risk factors for CD of the pouch.

Results: The study included 235 patients: AA (N = 26), HA (N = 37), IA (N = 22) and randomly selected Caucasian (N = 150) controls. Greater number of HA and Caucasians had a history of smoking than IA (27.3% and 27.0% vs. 0; p = 0.007). Caucasians and HA were also more likely to have a family history of IBD than IA or AA (25% vs. 27% vs. 5% vs. 4%; p = 0.016.) IA less frequently had extensive colitis before colectomy than Caucasians (71.4% vs. 94.0%; p = 0.004) and more frequently required anti-TNF biologics than HA (22.7% vs. 0; p = 0.016). On multivariable logistic regression analysis, AA (odds ratio [OR] = 10.1, 95% confidence interval [CI]: 1.03, 1365.8, p = 0.004) and Caucasians (OR = 11.1, 95% CI: 1.4, 1427.2, p = 0.015) had a higher risk of developing CD of the pouch than IA. However, the event-free survival was not significantly different between the groups on Cox regression analysis, presumably due to the sample size.

Conclusion: Racial background may be associated with different risk for the development of CD of the pouch for patients with IBD undergoing IPAA.

Keywords: Ethnicity; Ileal pouch-anal anastomosis; Inflammatory bowel disease; Race; Restorative proctocolectomy

Journal Article.  4311 words.  Illustrated.

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