P0433 Pouchitis described by the SES-CD score is more associated with the need for biologics initiation after IPAA than endoscopic subscore of PDAI
Authors: Simonič J , Simonič P , Bislenghi G , D’Hoore A , Verstockt B , Ferrante M , Vermeire S , Sabino J 
Published: January 2025

Abstract

Background
The ileal pouch-anal anastomosis (IPAA) is a well-established approach following proctocolectomy for ulcerative colitis (UC) or colorectal dysplasia. Although the functional results are good, many patients develop pouchitis. The pouchitis disease activity index (PDAI) is the most used tool to assess the inflammation of the pouch. However, the PDAI with endoscopic subscore of PDAI (ePDAI) is often not reliable or responsive (1, 2). The simplified endoscopic score for Crohn’s disease (SES-CD) has recently been proposed for this setting (3). In this retrospective study, we aim to describe the correlation between SES-CD score and several important clinical outcomes.

Methods
We performed a retrospective cohort study of patients who underwent IPAA surgery between March 2015 and February 2024 at out tertiary referral centre. According to internal hospital protocol, endoscopic and clinical examinations were performed at 1, 3, 6, and 12 months after IPAA for each patient. The ePDAI scores, demographics, comorbidities, laboratory tests and medication use were collected from the electronic medical records. Data was collected for the first year following IPAA surgery, and last known follow up. All pouchoscopies (n=497, 86.4% of total) with video- (83.5%) or photodocumentation (16.5 %) were reviewed by the same reviewer (JS) and additionally scored with SES-CD endoscopic score in the pouch body and afferent ileum. Descriptive and univariate analyses was performed. Kaplan-Meier curves were used to assess the impact of the ePDAI and SES CD scores for initiation of biologics. Pouchoscopies were classified as low-grade (ePDAI ≤ 1; SES CD ≤ 3) or high-grade inflammation (ePDAI &gt; 1; SES CD &gt; 3).

Results
The total cohort included 206 patients (46.1% female), of which 90.3% underwent IPAA surgery due to ulcerative colitis with a median follow up of 25 months after IPAA construction. Of those, 12.6% were receiving biologic therapy at the last follow up. There was linear corelation between ePDAI and SES-CD score (rho 0.69, p&lt;0.001). For both scores, the patients with high-grade inflammation pouchoscopy at months 1 (p 0.0132 for ePDAI, p 0.0008 for SES-CD) and 6 (p 0.0001 for ePDAI, p 0.0007 for SES-CD) had a higher need for biologic therapy than patients with low-grade pouchoscopy. At month 3 and 12, only SES-CD was associated with higher need for biologic therapy (month 3: p 0.467 for ePDAI, p 0.042 for SES-CD; month 12: p 0.0571 for ePDAI and p 0.0387 for SES CD).

Conclusion
The SES-CD score may be an alternative to ePDAI for scoring of pouch inflammation. The pouch inflammation described by the SES-CD score is more associated with the need for biologics initiation in patients after IPAA than ePDAI.

References
(1)Jairath V, Feagan BG, Silverberg MS, et al. Mucosal healing with vedolizumab in patients with chronic pouchitis: EARNEST, a randomized, double-blind, placebo-controlled trial. Clin Gastroenterol Hepatol. Published online 2024. doi: 10.1016/j.cgh.2024.06.037
(2)Sedano R, Nguyen TM, Almradi A, et al. Disease activity indices for pouchitis: A systematic review. Inflamm Bowel Dis. 2022;28(4):622-638. doi:10.1093/ibd/izab124
(3)Barnes EL, Long MD, Raffals L, et al. Development of the endoscopic pouch score for assessment of inflammatory conditions of the pouch. Clin Gastroenterol Hepatol. 2023;21(6):1663-1666.e3. doi: 10.1016/j.cgh.2022.04.026