Abstract Background Patients undergoing ileal pouch-anal anastomosis (IPAA) for inflammatory bowel disease (IBD) commonly experience post-operative inflammatory complications, including inflammation of the pouch (pouchitis) and rectal cuff (cuffitis). While pelvic floor dysfunction has been associated with these complications, the predictive value of pre-operative anorectal manometry (ARM) remains unclear. In this study, we assessed whether abnormal pre-operative ARM predicts post-operative endoscopic inflammatory outcomes in IPAA patients. Methods This historical cohort study assessed IBD patients who underwent pre-operative ARM with completion of their IPAA surgical series between January 2009 and December 2024. Patients were divided into two groups – normal versus abnormal pelvic floor function – based on ARM prior to completion of IPAA surgical series. Endoscopic pouchitis was defined as at least one of the following after the 6-month perioperative period: pouch disease activity index (PDAI) score ≥ 4, mucosal breaks beyond anastomotic lines, or diffuse pouch inflammation. Endoscopic pouch outcomes were assessed individually and in composite. Cuffitis was defined as rectal cuff inflammation noted on at least one endoscopic evaluation after the peri-operative period. Multivariable logistic regression was used to assess outcomes while controlling for covariates. Results This study included 179 patients, 46 (25.7%) in the abnormal ARM group and 133 (74.3%) in the normal ARM group. Cohorts had similar demographic and pre-operative characteristics except for gender; there was a higher proportion of females in the abnormal ARM group (63.0% versus 45.1%; p = 0.036). Median follow-up time was similar (2.88 years versus 3.61 years; p = 0.347) and there was no significant difference in pre-operative exposure to steroids or biologic/small molecule therapies. In total, 72 (40.2%) patients developed cuffitis, 61 (34.1%) developed endoscopic pouchitis, and 22 (12.3%) specifically developed diffuse pouch inflammation. In multivariable regression, patients with abnormal ARM had a higher risk of cuffitis (OR 2.14; 95% CI 1.05-4.37; p = 0.036; Table 1) and diffuse pouch inflammation (OR 2.62; 95% CI 1.00-6.78; p = 0.046; Table 2) but not overall endoscopic pouchitis (p = 0.427). Conclusion Abnormal pre-operative ARM was associated with post-operative cuffitis and diffuse pouch inflammation in IPAA patients after adjusting for potential confounders, which aligns with results from our pilot study. These findings suggest that pre-operative ARM may help identify patients at risk for specific inflammatory complications. The associations between pre-operative ARM and specific endoscopic outcomes as well as the underlying mechanisms merit further investigation. Conflict of interest: Ms. Dester, Emma: Crohn’s and Colitis Foundation Student Research Fellowship Award 2025 recipient American College of Gastroenterology Medical Student Research Award 2025 recipient Powers, Carter: No conflict of interest Smith, Riley: No conflict of interest Kwong, Zeeyong: No conflict of interest Zemanek, Mark: No conflict of interest Spivak, Anna: Medtronic: Consulting, Education. Cohen, Benjamin: Abbvie - consulting and speaking ALPCO - consulting J & J Innovative Medicine - consulting Takeda - consulting and speaking Emmes Biopharma Services LLC - DSMB Pfizer - consulting Falloon, Katherine: Pfizer: Principal investigator for research collaboration Janssen Pharmaceuticals: Consultant Bracco, S.p.A: Consultant. Takeda Pharmaceuticals: Speaker, Trainer, Educator. Hull, Tracy: No conflict of interest Lashner, Bret: No conflict of interest Qazi, Taha: Abbvie: Consulting, Speakers Bureau Johnson and Johnson: Consulting, Speakers Bureau Eli Lilly: Consulting Pfizer: Consulting.
Dester et al. (Thu,) studied this question.