QS125 - Clinical Validation of the Ileoanal Pouch Syndrome Severity Index and the Ileoanal Pouch Syndrome Distress Inventory in a Multicenter Cohort

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Purpose/Background: Ileal pouch-anal anastomosis (IPAA) surgery changes the anatomy and physiology of defecation to create a new bowel function profile. A previous Delphi consensus established a definition of Ileoanal Pouch Syndrome (IPS), which occurs when function is suboptimal. We validated a weighted IPS Severity Index (IPS-SI) and an IPS Distress Inventory (IPS-DI) to help identify and monitor IPS patients. The primary objective of this study was to offer additional clinical characterization of the features of IPS when measured by IPS-SI and IPS-DI; and to determine IPS impact on sexual function, fertility and bowel function-related QOL in a multicenter cohort.

Methods/Interventions: 165 IPAA patients from five medical centers in the United States completed IPS-SI and IPS-DI surveys; provided information on experiences with and severity of pouchitis and cuffitis; and provided data on IBD-Specific Male and Female Sexual Dysfunction Scales (IBD-MSDS and IBD-FSDS). These answers were merged with clinical and surgical data (e.g. surgical indications, number of surgical stages, type of anastomosis, and septic pelvic complications). IPS-SI and IPS-DI were then evaluated for changes based on the occurrence of particular clinical events. The relationships between IPS-SI/IPS-DI and IBD-MSDS/IBD-FSDS were also compared. Analysis was performed using Student’s T-test, chi-square, Fisher’s exact test, and ROC curves.

Results/Outcomes: 165 patients (87 males, 52.7%; age 51.5 ± 15.6 years) were included in the study. Majority required surgery for medically-refractory colitis (n=134, 81.2%) and more than half (n= 90; 54.5%) had 3-stage IPAAs. 47 (28.5%) patients did not meet criteria for IPS. 29 (17.8%) patients reported mild IPS (IPS-SI>15); 36 (21.8 %) had moderate IPS (IPS-SI>30) and 53 (32.1%) had severe or extremely severe IPS (IPS-SI>45 and IPS-SI>60). Most IPAA patients reported some QOL improvements after surgery, but the percentage of improved patients varied by IPS severity at 92.9%, 71.4%, and 46.2% (P=0.006) for mild, moderate and severe IPS, respectively. Similarly, IPS-DI scores also worsened based on IPS severity at 1.4 ± 2.0 (no IPS), 8.0 ± 3.3 (mild IPS), and 15.5 ± 5.8 (moderate IPS) to 28.0 ± 8.4 (severe IPS, p < 0.001), respectively.

Patients with prior refractory colitis had a more positive perception of their new pouch function and were less likely to report IPS when compared to patients with prior dysplasia (92.1% vs. 70%, p=0.026). IPS-SI and IPS-DI scores both worsened with certain clinical occurrences associated with poor bowel function (e.g. pouch leak) [Figure 1]. Patients with IPS symptoms also reported increased sexual dysfunction [Figure 2], which worsened in both genders (IBD-MSDS: 8.7 ± 3.7 in no IPS to 13.9 ± 8.5 in severe IPS; IBD-FSDS: 20.4 ± 4.6 in no IPS to 30.3 ± 9.3 in severe IPS); with R for IPS symptoms = 0.24 (p=0.035) and R for IPS consequences = 0.36 (p=0.001); and R for IPS distress = 0.272 (p=0.018).

Conclusion/Discussion: In this study, we continue the characterization of IPS using the IPS-SI and the IPS-DI scores and highlight the need to monitor IPS in IPAA patients due to its significant impact on QOL. We report the differences in the impact of mild, moderate and severe IPS on patient perception of distress and sexual function to advocate for a systematic measurement and monitoring of IPAA patients and their rates of IPS using validated scores. This would aid the identification of the IPS patients who would benefit most from further therapy.