Simplification of the pouchitis scoring system and analysis of antibiotic treatment outcomes after ileal pouch-anal anastomosis for ulcerative colitis: based on the modified Pouchitis Disease Activity Index
- 1Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, Zhejiang, China
Abstract
Objectives To construct a simplified Pouchitis Disease Activity Index (sPDAI) scoring system based on the core assessment items of the modified Pouchitis Disease Activity Index (mPDAI), to analyze the relationship between antibiotic treatment outcomes and baseline mPDAI scores in patients with pouchitis, and to analyze the efficacy of infliximab in antibiotic-refractory pouchitis. Methods Clinical data of 102 patients who underwent ileal pouch-anal anastomosis (IPAA) for ulcerative colitis at our center between January 2015 and December 2025 were retrospectively analyzed, including data from hospitalization and follow-up. Based on the completion of pouch endoscopy and concurrent mPDAI assessment, patient episodes were divided into pouchitis and non-pouchitis groups. The core assessment items of the mPDAI were analyzed, and an sPDAI scoring system was constructed based on these core items. Its diagnostic performance was then evaluated. Patients with pouchitis were further grouped according to antibiotic treatment outcomes (antibiotic-responsive, antibiotic-dependent, or antibiotic-refractory), and baseline mPDAI scores were compared among groups. The short-term efficacy of infliximab in antibiotic-refractory pouchitis was also analyzed. Results A total of 231 episodes of pouch endoscopy with concurrent mPDAI assessment were completed, including 43 episodes in the pouchitis group and 188 in the non-pouchitis group. Among the 102 patients, 31 were diagnosed with pouchitis. Of these 31 patients, 26 were included in the analysis of antibiotic treatment outcomes. The items regarding endoscopic manifestations and defecation frequency belong to the core items of the mPDAI for evaluating pouchitis. Based on this,the “total score of endoscopic items” and the “increase of 2 or more times in daily defecation frequency compared to postoperative period” were set as items and a sPDAI scoring system was constructed (with a total score range of 0 to 7 points). The final cut-off value for evaluating pouchitis was set at 4, with a sensitivity of 92.9% and a specificity of 93.1%, demonstrating good diagnostic efficacy. There was no statistically significant difference in baseline mPDAI scores among the antibiotic- responsive, antibiotic-dependent, and antibiotic-refractory groups (P＞0.05). In the antibiotic-refractory group, 6 patients received infliximab therapy, and 5 of those who completed 6 months of follow-up achieved clinical remission. Conclusion The sPDAI scoring system, constructed using the “total score of endoscopic items” and “increase of 2 or more times in daily defecation frequency compared to postoperative period” demonstrates good diagnostic efficacy. Baseline mPDAI scores were comparable among patients with different antibiotic treatment outcomes. For patients with antibiotic-refractory pouchitis, infliximab shows favorable short-term efficacy.
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BibTeX
@article{zhicheng2026simplification,
title = {{Simplification of the pouchitis scoring system and analysis of antibiotic treatment outcomes after ileal pouch-anal anastomosis for ulcerative colitis: based on the modified Pouchitis Disease Activity Index}},
author = {Wang Zhicheng and Ge Xiaolong and Liu Wei and Zhou Wei},
journal = {结直肠肛门外科},
year = {2026},
month = aug,
doi = {10.19668/j.cnki.issn1674-0491.2026.04.008},
url = {https://doi.org/10.19668/j.cnki.issn1674-0491.2026.04.008},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Simplification of the pouchitis scoring system and analysis of antibiotic treatment outcomes after ileal pouch-anal anastomosis for ulcerative colitis: based on the modified Pouchitis Disease Activity Index
AU - Wang Zhicheng
AU - Ge Xiaolong
AU - Liu Wei
AU - Zhou Wei
PY - 2026
DA - 2026/08/01
JO - 结直肠肛门外科
DO - 10.19668/j.cnki.issn1674-0491.2026.04.008
UR - https://doi.org/10.19668/j.cnki.issn1674-0491.2026.04.008
AB - Objectives To construct a simplified Pouchitis Disease Activity Index (sPDAI) scoring system based on the core assessment items of the modified Pouchitis Disease Activity Index (mPDAI), to analyze the relationship between antibiotic treatment outcomes and baseline mPDAI scores in patients with pouchitis, and to analyze the efficacy of infliximab in antibiotic-refractory pouchitis. Methods Clinical data of 102 patients who underwent ileal pouch-anal anastomosis (IPAA) for ulcerative colitis at our center between January 2015 and December 2025 were retrospectively analyzed, including data from hospitalization and follow-up. Based on the completion of pouch endoscopy and concurrent mPDAI assessment, patient episodes were divided into pouchitis and non-pouchitis groups. The core assessment items of the mPDAI were analyzed, and an sPDAI scoring system was constructed based on these core items. Its diagnostic performance was then evaluated. Patients with pouchitis were further grouped according to antibiotic treatment outcomes (antibiotic-responsive, antibiotic-dependent, or antibiotic-refractory), and baseline mPDAI scores were compared among groups. The short-term efficacy of infliximab in antibiotic-refractory pouchitis was also analyzed. Results A total of 231 episodes of pouch endoscopy with concurrent mPDAI assessment were completed, including 43 episodes in the pouchitis group and 188 in the non-pouchitis group. Among the 102 patients, 31 were diagnosed with pouchitis. Of these 31 patients, 26 were included in the analysis of antibiotic treatment outcomes. The items regarding endoscopic manifestations and defecation frequency belong to the core items of the mPDAI for evaluating pouchitis. Based on this,the “total score of endoscopic items” and the “increase of 2 or more times in daily defecation frequency compared to postoperative period” were set as items and a sPDAI scoring system was constructed (with a total score range of 0 to 7 points). The final cut-off value for evaluating pouchitis was set at 4, with a sensitivity of 92.9% and a specificity of 93.1%, demonstrating good diagnostic efficacy. There was no statistically significant difference in baseline mPDAI scores among the antibiotic- responsive, antibiotic-dependent, and antibiotic-refractory groups (P＞0.05). In the antibiotic-refractory group, 6 patients received infliximab therapy, and 5 of those who completed 6 months of follow-up achieved clinical remission. Conclusion The sPDAI scoring system, constructed using the “total score of endoscopic items” and “increase of 2 or more times in daily defecation frequency compared to postoperative period” demonstrates good diagnostic efficacy. Baseline mPDAI scores were comparable among patients with different antibiotic treatment outcomes. For patients with antibiotic-refractory pouchitis, infliximab shows favorable short-term efficacy.
SN - 1674-0491
ER -