Background: Previous studies have shown a decreased risk of disease onset, steroid use and colorectal cancer in patients with IBD who use statins. We have investigated the effect of statins in preventing pouch-associated complications in patients with ulcerative colitis who have undergone total proctocolectomy and ileal pouch-anal anastomosis.
Methods: We designed a retrospective case-control study of UC patients who have undergone proctocolectomy and IPAA followed at the Johns Hopkins Meyerhoff IBD Center between 2003 and 2016. Patient characteristics including demographics, tobacco use, personal and family history, past and current medical therapy, surgeries and pouch related complications (acute pouchitis, chronic pouchitis, fistula, and stricture) were collected.
Cases were defined as patients who had used statins for at least 2 years prior to their last recorded encounter with a physician. Controls were patients who had never used statins, matched in a 1:2 ratio to controls, according to the duration of IPAA (years). Matched controls were randomly selected from a pool of eligible controls. At time of enrollment, all cases and controls were asymptomatic, had no history of chronic pouchitis, fistula or stricture and required one or none antibiotic course.
Pouch related complications registered during the 2 years of follow up were compared between cases and controls. The results were adjusted for steroid, antibiotic (ciprofloxacin or metronidazole) and anti-TNF use during the study.
Statistical analysis was performed using t-tests and Fisher's exact test. P values less than 0.05 were considered significant.
Results: A total of 17 cases were compared with 34 controls. Males predominated our cohort (54.9%) but no significant difference was noted in gender distribution among cases and controls. As expected, cases were older than controls. The average age was 63.5 vs 40.7 years old, p<0.0001. The mean duration of IPAA was 7.75±5.1 years (median=6 years).
Overall, cases were less likely to develop pouch related complications (6/17 (35.2%) vs 26/34 (76.5%), p<0.0062) or need antibiotic therapy when compared to controls (29.4% vs 64.7%).
Conclusions: Statin use was associated with a statistically significant reduced rate of pouch-related complications and antibiotic use. Further prospective studies are needed to confirm our findings.