A Single-Center Retrospective Review on Prevalence and Outcomes of Pouchitis and Pouch-Related Complications After Total Proctocolectomy With Ileal-Pouch Anal Anastomosis for Ulcerative Colitis

Background: Restorative proctocolectomy with ileal pouch-anal anastomosis (RP-IPAA) is the standard surgical treatment for ulcerative colitis (UC). Pouchitis is the most common inflammatory and long-term, non-surgical complication after RP-IPAA. It is defined as inflammation of the ileal pouch, a surgically created artificial rectum in patients who have undergone RP-IPAA. We performed a retrospective cohort study to evaluate the prevalence of pouchitis among patients at our institution after total proctocolectomy with ileal pouch-anal anastomosis (IPAA) for ulcerative colitis. Methods: The study was approved by the Institutional Review Board at the University of South Florida (USF). All consecutive patients at the USF Inflammatory Bowel Diseases Center with a diagnosis of ulcerative colitis who underwent total proctocolectomy with ileal pouch-anal anastomosis (IPAA) at any point in time were eligible for inclusion. Exclusion criteria included an initial diagnosis of Crohn’s disease and surgery other than IPAA. The primary outcome was prevalence of pouchitis among patients at our institution after IPAA. Secondary outcomes included rates of acute vs. recurrent pouchitis, healthcare utilization, and post-surgical complications. All demographic, clinical, and surgical data were extracted from the electronic health record. Results were summarized as rates/percentages for categorical variables and mean/median along with standard deviation (SD) for continuous variables. The difference in categorical variables across the compared groups was assessed using the binary logistic regression and summarized as odds ratio (OR) along with 95% CI. The Kaplan-Meier curve was calculated for time-dependent variables. All data analysis was performed using the IBM SPSS version 28 statistical analysis package. Results: Overall, 100 patients met the inclusion criteria. Of the patients with pouchitis, 35% (25) had isolated acute pouchitis and 65% (47) had recurrent pouchitis. Demographic data and patient characteristics were similar among patients with and without pouchitis, although there was a greater prevalence of former tobacco use among patients with vs. without pouchitis (23.6 % vs. 17.9%, p = 0.013). The overall prevalence of pouchitis was 72%. There was no significant difference in the mean time to total proctocolectomy with IPAA in those with and without pouchitis (108 ±95 and 134 ±106, respectively, p=0.27). There were similar rates of surgical pouch complications (36.1% vs. 28.6%, p=0.64), small bowel obstruction after IPAA (29.6% vs. 40.7%, p=0.34), and end ileostomy after IPAA (4.3% vs 10.7%, p=0.35) in both groups. There was no difference in mean number of ER visits, hospitalizations, and outpatient visits among patients with and without pouchitis. The odds of developing pouchitis did not differ significantly when comparing any demographic or clinical characteristics. The prevalence of diagnosis of Crohn’s disease after IPAA for UC was 19%. Time to initial episode of pouchitis is depicted. Conclusions: In our study, the prevalence of pouchitis was high (72%) in patients with UC who had undergone RP-IPAA, with 35% of patients having an isolated episode of acute pouchitis. We found no difference in the post-surgical complications or utilization of healthcare resources among patients with or without pouchitis. This striking prevalence of pouchitis highlights the need for further research into the prevention and management of pouchitis.