Key Risk Factors for Pouchitis After Ileal Pouch-Anal Anastomosis

NEW data have identified primary sclerosing cholangitis and preoperative steroid use as the most reliable risk factors for pouchitis after ileal pouch-anal anastomosis (IPAA) in patients with ulcerative colitis (UC), while highlighting continued uncertainty around several other proposed predictors. 

Review Examines Pouchitis Risk 

Researchers conducted a systematic review of studies published between January 2006 and December 2025 to assess risk factors for pouchitis after IPAA. Literature searches were performed across PubMed, Embase, and the Cochrane Library using terms relating to UC, IPAA, pouchitis, and risk factors. 

Two reviewers independently assessed studies against predefined inclusion and exclusion criteria. Meta-analysis used inverse-variance weighting, with fixed or random effects models selected according to heterogeneity. 

The review included 49 eligible citations. Reported risk factors were grouped into six categories: clinical, endoscopic, histological, laboratory, genetic, and other factors. 

Pouchitis After IPAA Shows Several Associations 

Preoperative steroid use and primary sclerosing cholangitis (PSC) emerged as reliable risk factors based on consistent findings from multivariable analyses. Pooled analyses also identified four factors associated with pouchitis: male sex (odds ratio: 1.34; 95% CI: 1.00–1.79), PSC (odds ratio: 3.52; 95% CI: 2.53–4.90), preoperative steroid use (odds ratio: 1.89; 95% CI: 1.48–2.41), and preoperative antitumour necrosis factor therapy (odds ratio: 1.35; 95% CI: 1.17–1.57). 

Other factors, including extraintestinal manifestations and shorter J-pouch length, were associated with pouchitis in multiple studies, although findings were not consistent. 

Further Validation Remains Needed 

The authors noted that smoking, age, and sex remained controversial risk factors because of conflicting evidence across studies. The findings therefore indicate that the risk profile for pouchitis after IPAA is not fully established. 

The review concluded that preoperative steroid exposure and PSC represented the most dependable risk factors identified. However, further large-scale prospective research is needed to validate additional predictors. The authors also highlighted the importance of standardised diagnostic criteria and consistent research methods when assessing potential risk factors for pouchitis after IPAA. 

Reference 

Du H et al. Risk factors for pouchitis after ileal pouch-anal anastomosis in ulcerative colitis patients. Turk J Gastroenterol. 2026;DOI:10.5152/tjg.2026.25594.  

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