What is the risk of pouchitis after IPAA for UC

What is known

- Cumulative frequency of pouchitis 10–11 years after IPAA has been reported as 23% to 46%. ¹ - Patients with primary sclerosing cholangitis had markedly higher pouchitis risk (63% vs 32%; 79% vs 45.5% at 10 years) and more chronic pouchitis. ² - Extraintestinal manifestations raised 5-year pouchitis risk to 48.1% versus 4.6% without EIMs in one cohort. ³ - Reported risk factors include younger disease onset, extensive colonic disease, EIMs, preoperative steroid use, and NOD2/CARD15 polymorphisms; risk is high in pediatric patients. ^1,4

What is unknown / caveats

- Reported incidence varies widely across cohorts (roughly 9%–12% to 45–80% depending on follow-up and population) - Estimates come from heterogeneous single-institution and pediatric cohorts with differing diagnostic criteria and follow-up - Some reviews note the proportion developing pouchitis may be increasing over recent decades - A single point-estimate does not exist; risk depends heavily on follow-up duration and patient subgroup.

## References

1. Dharmaraj R, Dasgupta M, Simpson P, Noe J. Predictors of Pouchitis After Ileal Pouch-Anal Anastomosis in Children. J Pediatr Gastroenterol Nutr. 2016;63:e58-62. PMID: 27243421.

2. Penna C, Dozois R, Tremaine W, Sandborn W, LaRusso N, Schleck C, Ilstrup D. Pouchitis after ileal pouch-anal anastomosis for ulcerative colitis occurs with increased frequency in patients with associated primary sclerosing cholangitis. Gut. 1996;38:234-9. PMID: 8801203.

3. Hata K, Watanabe T, Shinozaki M, Nagawa H. Patients with extraintestinal manifestations have a higher risk of developing pouchitis in ulcerative colitis: multivariate analysis. Scand J Gastroenterol. 2003;38:1055-8. PMID: 14621280.

4. Cowherd E, Egberg MD, Kappelman MD, Zhang X, Long MD, Lightner AL, Sandler RS, Herfarth HH, Barnes EL. The Cumulative Incidence of Pouchitis in Pediatric Patients With Ulcerative Colitis. Inflamm Bowel Dis. 2022;28:1332-1337. PMID: 35040995.

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_Draft, generated by the IBDology RAG and not yet clinician-reviewed. Answers are grounded in the retrieved literature listed above; a high faithfulness score means the answer matches its sources, not that the sources are correct._