Severe Disease Activity Despite anti-TNF-α Treatment may Predispose to Post-colectomy Duodenitis Associated with Ulcerative Colitis

Abstract BackgroundDiffuse mucosal inflammation in the duodenum that is distinct from peptic ulcer diseases has been repeatedly reported in patients with ulcerative colitis (UC). The pathogenesis of this complication remains uncertain, however, a colectomy for medically-refractory UC appears to trigger the duodenitis. We investigated the risk factors, treatments, and prognosis of UC-related duodenitis presented after colectomy. Methods We performed a case series study of 152 patients with UC who underwent colectomy for the development of UC-related duodenitis between January 2011 and June 2020. Clinical and laboratory data, disease severity, medications were collected to see the associations with UC-related duodenitis. ResultsEleven UC-related duodenitis cases were identified among 55 colectomy cases of UC who received esophagogastroduodenoscopy (EGD) due to epigastric symptoms. Disease severity defined by CRP and partial Mayo score prior to colectomy was significantly higher in patients with UC-related duodenitis than the controls. Among the medications used before colectomy, only anti-TNF-α agents were significantly associated with the development of UC-related duodenitis (OR 5.4, 95% CI: 1.456 - 22.82, P=0.02). Most UC-related duodenitis patients responded to Mesalamine or corticosteroid, and did not experience relapses but four cases (36.4%) needed treatment escalations to control bleeding. Three UC-related duodenitis patients (27.3%) were eventually treated with biologics due to concomitant pouchitis and/or UC-like enteritis. ConclusionsUC patients with higher disease activity and the use of anti-TNF-α agents prior to colectomy appear to be at high risk of developing UC-related duodenitis. A relapse is rare in UC-related duodenitis but maintenance therapies may be needed if it’s complicated with pouchitis.