Frontiers in medicine · 2026
Risk factors for chronic pouchitis in patients with ulcerative colitis following ileal pouch-anal anastomosis: a meta-analysis.
СтатьяСистематический обзорНазвание и аннотация: Перевод в очереди
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Meng Zhen, Yi Hongli, Yu Shuxia, Chen Jing, Sun Minhui
Аннотация
BACKGROUND: Chronic pouchitis is one of the common complications following ileal pouch-anal anastomosis (IPAA) in patients with ulcerative colitis (UC), and its pathogenesis and risk factors remain incompletely understood. Therefore, this study aims to evaluate the association between multiple potential risk factors and the occurrence of postoperative chronic pouchitis in UC patients through a systematic meta-analysis.
METHODS: Databases including PubMed, Embase, Cochrane Library, and Web of Science were searched up to January 20, 2026. Eligible cohort studies and case-control studies were included. Study quality was assessed using the Newcastle-Ottawa Scale (NOS). Meta-analysis employed a random-effects model to calculate the odds ratio (OR) and 95% confidence interval (CI) for each factor associated with chronic pouchitis. All statistical analyses were performed using Stata 15.0 (StataCorp LLC, College Station, TX, USA) software.
RESULTS: Thirteen studies involving 4,264 patients with UC undergoing IPAA were included, of whom 916 developed chronic pouchitis. The pooled analysis showed that female sex (OR = 1.36, 95% CI: 1.05-1.76), current smoking (current smokers vs. never-smokers; OR = 2.46, 95% CI: 1.28-4.75), primary sclerosing cholangitis (OR = 2.30, 95% CI: 1.43-3.72), preoperative systemic steroid use (OR = 1.61, 95% CI: 1.10-2.36), immunosuppressive therapy (OR = 1.32, 95% CI: 1.02-1.70), and extraintestinal manifestations (OR = 3.09, 95% CI: 1.65-5.77) were associated with increased risk of chronic pouchitis. Increasing age was associated with chronic pouchitis in the primary analysis; however, this association was not statistically significant after trim-and-fill adjustment, suggesting potential influence of publication bias.
CONCLUSIONS: Several clinical factors, including female sex, current smoking, primary sclerosing cholangitis, preoperative steroid or immunosuppressive use, and extraintestinal manifestations, are associated with an increased risk of chronic pouchitis after IPAA. The association between age and chronic pouchitis appears unstable and should be interpreted cautiously. These findings may assist in identifying high-risk patients and guiding postoperative surveillance; however, further prospective studies are needed to confirm these associations.
METHODS: Databases including PubMed, Embase, Cochrane Library, and Web of Science were searched up to January 20, 2026. Eligible cohort studies and case-control studies were included. Study quality was assessed using the Newcastle-Ottawa Scale (NOS). Meta-analysis employed a random-effects model to calculate the odds ratio (OR) and 95% confidence interval (CI) for each factor associated with chronic pouchitis. All statistical analyses were performed using Stata 15.0 (StataCorp LLC, College Station, TX, USA) software.
RESULTS: Thirteen studies involving 4,264 patients with UC undergoing IPAA were included, of whom 916 developed chronic pouchitis. The pooled analysis showed that female sex (OR = 1.36, 95% CI: 1.05-1.76), current smoking (current smokers vs. never-smokers; OR = 2.46, 95% CI: 1.28-4.75), primary sclerosing cholangitis (OR = 2.30, 95% CI: 1.43-3.72), preoperative systemic steroid use (OR = 1.61, 95% CI: 1.10-2.36), immunosuppressive therapy (OR = 1.32, 95% CI: 1.02-1.70), and extraintestinal manifestations (OR = 3.09, 95% CI: 1.65-5.77) were associated with increased risk of chronic pouchitis. Increasing age was associated with chronic pouchitis in the primary analysis; however, this association was not statistically significant after trim-and-fill adjustment, suggesting potential influence of publication bias.
CONCLUSIONS: Several clinical factors, including female sex, current smoking, primary sclerosing cholangitis, preoperative steroid or immunosuppressive use, and extraintestinal manifestations, are associated with an increased risk of chronic pouchitis after IPAA. The association between age and chronic pouchitis appears unstable and should be interpreted cautiously. These findings may assist in identifying high-risk patients and guiding postoperative surveillance; however, further prospective studies are needed to confirm these associations.