Risk factors associated with the development of chronic pouchitis following ileal-pouch anal anastomosis surgery for ulcerative colitis

doi:10.13105/wjma.v13.i1.101226

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World Journal of Meta-Analysis

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Meta-Analysis

World J Meta-Anal. Mar 18, 2025; 13(1): 101226
Published online Mar 18, 2025. doi: 10.13105/wjma.v13.i1.101226

Risk factors associated with the development of chronic pouchitis following ileal-pouch anal anastomosis surgery for ulcerative colitis

Emi Khoo, Robert Gilmore, Alison Griffin, Gerald Holtmann, Jakob Begun

Emi Khoo, Robert Gilmore, Jakob Begun, Department of Gastroenterology, Mater Hospital Brisbane, South Brisbane 4101, Queensland, Australia

Emi Khoo, Robert Gilmore, Jakob Begun, IBD Clinical Trial Unit, Mater Research Institute, South Brisbane 4101, Queensland, Australia

Emi Khoo, Robert Gilmore, Gerald Holtmann, Jakob Begun, Faculty of Medicine, University of Queensland, St Lucia 4067, Queensland, Australia

Alison Griffin, QIMR Berghofer Medical Research Institute, Herston 4006, Queensland, Australia

Gerald Holtmann, Department of Gastroenterology, Princess Alexandra Hospital, Woolloongabba 4102, Queensland, Australia

Author contributions: Khoo E conducted data extraction and wrote the manuscript; Khoo E, Holtmann G and Begun J designed the research study; Khoo E and Gilmore R reviewed literature search and select eligible articles; Griffin A performed statistical analysis and verified data extraction; all authors have read and approved the final manuscript to be published.

Conflict-of-interest statement: Khoo E has received research funding from Pfizer and Celltrion; as well as speaker funding from Ferring. Begun J has received speaking or consulting fees from Ferring, Takeda, Janssen, Pfizer, Abbvie, Dr. Falk, Celltrion, Amgen, and Sandoz. Gilmore R, Griffith A and Holtmann G have nothing to disclose.

PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.

Corresponding author: Emi Khoo, BMed, FRACP, MBBS, Staff Physician, Department of Gastroenterology, Mater Hospital Brisbane, Raymond Terrace, South Brisbane 4101, Queensland, Australia. emi.khoo@mater.uq.edu.au

Received: September 8, 2024
Revised: January 30, 2025
Accepted: February 27, 2025
Published online: March 18, 2025
Processing time: 186 Days and 19.1 Hours

Abstract

BACKGROUND

Chronic pouchitis remains a significant and prevalent complication following ileal pouch-anal anastomosis in patients with ulcerative colitis.

AIM

To identify potential risk factors for the development of chronic pouchitis.

METHODS

Predictors of chronic pouchitis were investigated through a systematic review and meta-analysis. A comprehensive search of the Medline, EMBASE, and PubMed databases was undertaken to identify relevant studies published up to October 2023. Meta-analytic procedures employed random-effects models for the combination of estimates, with the I² statistic used to assess between-study heterogeneity.

RESULTS

Eleven studies with a total of 3722 patients, comprising 513 with chronic pouchitis and 3209 patients without, were included in the final analysis. Extraintestinal manifestation [odds ratio (OR) = 2.11, 95% confidence intervals (CI): 1.53-2.91, P < 0.001, I² = 0%], specifically primary sclerosing cholangitis (PSC) (OR = 3.69, 95%CI: 1.40-9.21, P = 0.01, I² = 48%), and extensive colitis (OR = 1.96, 95%CI: 1.23-3.11, P = 0.00, I² = 31%) were associated with an increased risk of chronic pouchitis. Other factors, including gender, smoking status, family history of inflammatory bowel disease and ileal pouch anal anastomosis surgical indication were not significantly associated with chronic pouchitis.

CONCLUSION

Extraintestinal manifestations, PSC and extensive colitis are associated with the development of chronic pouchitis. These findings underscore the importance of comprehensive pre-operative assessment and tailored post operative management strategies.

Keywords: Ulcerative colitis; Ileal pouch-anal anastomosis; Pouch; Chronic pouchitis; Risk factor

Core Tip: Pouchitis is the most frequent complication after ileal pouch anal anastomosis (IPAA) surgery. This condition can significantly impact a person's quality of life, leading to social isolation. Identifying the risk factors of chronic pouchitis could lead to more personalized patient care, better preoperative counselling, and potential interventions to reduce the risk of chronic pouchitis in patients undergoing IPAA surgery for ulcerative colitis in the future and improve long-term outcomes.