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Came across this abstract in my GI Linx Newsletter today. Seems that a predictive factor for chronic pouchitis is long term or high dose steroids immediately prior to surgery. Of course, my minds goes to the questions:

Is it the steroids that predispose (cause and effect), or is it the subtype of UC that is so severe that large amounts of steroids are used unsuccessfully, resulting in a more urgent basis colectomy?

Also, does it mean that the move toward more reliance on biologics for disease control than steroids will lead to less incidence of chronic pouchitis once colectomy becomes necessary? They are saying that these drugs are already reducing the colectomy rates

Still, it is interesting to note this. So, if you were on high dose or long term steroids going into surgery, you may be at a higher risk of that occasional bout of pouchitis becoming chronic.

http://www.ncbi.nlm.nih.gov/pubmed/23949485

Jan Smiler

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I was on mega doses of Prednisone unfortunately. So far...knock wood...it's been three years and I haven't had pouchitis yet. In the grand scheme of things my pouch is just a baby so who knows what the future will bring. My sister told me that in her 21 years with her j pouch she hasn't experienced pouchitis and she was on prednisone way longer than me. Interesting though.
mgmt10
we're the other side - my son was only on steroids for a very short time as they didnt work for him. He was put on higher risk meds like Tacrolimus then 6MP then eventually Remicade. Since surgery over 5 years ago he has had mild pouchitis pretty much continuously. The only symptoms he has is leakage at night. It's usally very light and he's learning to control it based on what he eats in the evening.
A
No, the study was based on the entire 244 patients that met the inclusion criteria. What is not stated in the abstract is whether UC was an inclusion criterium. So, there could be some with FAP, who have a very low pouchitis risk. That might explain the low pouchitis incidence in the study group. I believe other studies I've read indicate pouchitis rates closer to 50% for IBD patients.

What the study was saying is that it was taking high dose or long term steroids right before surgery was a risk factor, not just taking steroids at all. So, if you had been taking 20 mg or less for less than a couple of months, you are not in that group.

To me, it may not be all that meaningful, because it largely is an indication that if your disease was severe at the time of surgery, THAT might be the real factor. It might place you in a particular subtype. But, still, it could be cause and effect from the drug too.

Jan Smiler
Jan Dollar

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