https://orcid.org/0000-0003-1317-183X
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Cong Dai, Yu-hong Huang, Extraintestinal Manifestations in Patients With Ulcerative Colitis Post-Restorative Proctocolectomy and Ileal Pouch-Anal Anastomosis, Inflammatory Bowel Diseases, 2025;, izaf080, https://doi.org/10.1093/ibd/izaf080
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To the Editors, we read with great interest the study by Barenboim A et al investigating the prevalence and associated factors of extraintestinal manifestations (EIMs) in ulcerative colitis (UC) patients following ileal pouch-anal anastomosis (IPAA).1 The findings highlight that nearly half (46.78%) of post-IPAA patients develop EIMs, with musculoskeletal manifestations dominating. Importantly, preoperative EIMs persisted in 82.75% of cases, challenging the assumption that colectomy resolves systemic immune dysregulation.
The identification of preoperative musculoskeletal EIMs (odds ratio [OR] 8.2), postoperative pouch complications (OR 2.2), and non-Ashkenazi origin (OR 2.1) as independent risk factors for post-IPAA EIMs is clinically significant. These associations suggest that residual immune activation—potentially driven by pouch inflammation or genetic and environmental factors—may perpetuate EIMs. The link between chronic pouchitis/Crohn’s-like disease of the pouch and EIMs underscores the need for aggressive management of postoperative inflammation. Furthermore, the ethnic disparity (non-Ashkenazi origin) warrants exploration into genetic polymorphisms (eg, NOD2) or environmental triggers unique to this cohort.
