Incidence and Long-Term Outcomes of Pouchitis in Ulcerative Colitis Patients

BACKGROUND: Ileal pouch-anal anastomosis (IPAA) is the preferred intervention for ulcerative colitis (UC) patients whose medical treatment fails. Acute severe ulcerative colitis (ASUC) can precipitate the need for urgent surgery, potentially influencing post-IPAA outcomes.

OBJECTIVE: This study details the incidence, disease course, and treatment of pouchitis and pouch failure in a population-based cohort of UC patients following IPAA construction.

METHODS: We included all UC patients who underwent IPAA construction within two administrative regions in Denmark between November 1993 and April 2021 in a population-based cohort. Data spanning from diagnosis to January 2023 were manually extracted from electronic patient records and analyzed.

RESULTS: Among 233 patients, 118 (50.6%) experienced 519 pouchitis events. 437 (84.2%) had intermittent pouchitis, 60 (11.6%) had chronic antibiotic-dependent pouchitis, and 22 (4.2%) had chronic antibiotic-refractory pouchitis. There was no significant difference in the incidence of pouchitis between patients who underwent urgent surgery due to ASUC and those who underwent non-urgent surgery. Antibiotics were used in 89.6% of cases, with ciprofloxacin and metronidazole being the most common treatment. Thirty-two (13.7%) patients experienced 36 pouch failures, 6.9% experienced permanent pouch failure, with 8.3% of failures attributed to pouchitis.

CONCLUSION: Half of the patients with IPAA experienced at least one episode of pouchitis. ASUC did not appear to increase the risk of pouchitis. The overall incidence of pouch failure was low, with pouchitis contributing to a minority of failures.