The outcome of ulcerative colitis patients undergoing pouch surgery is determined by pre‐surgical factors

Summary Background Pouch surgery, a common intervention for ulcerative colitis (UC) complications, is often associated with the development of pouchitis. Aim To identify predictors of pouch outcome in a cohort of patients with UC. Methods We conducted a retrospective unmatched case‐cohort study in a tertiary IBD referral centre. Adult patients with UC were classified into the worst phenotype throughout follow‐up: normal pouch, a form of chronic pouchitis (either chronic pouchitis or Crohn's like disease of pouch [CLDP]), or episodic recurrent acute pouchitis (RAP). Risk factors for pouchitis (chronic forms) were detected using statistical models. Results Two hundred and fifty‐three pouch patients were followed up for 13.1±7.3 years. Only 71 patients (28.1%) maintained a favourable outcome of a sustained normal pouch. These patients were older at UC diagnosis (27.8±12.5 vs 23.0±11.4 years), had longer UC duration until surgery (13.4±9.5 vs 8.2±7.9 years), and had higher rates of referral to surgery due to nonrefractory (dysplasia/neoplasia) complications (42.3% vs 16.2%) compared with pouchitis patients. Median survival for sustained normal pouch was 10.8 years (95% CI 8.9‐12.7 years), and it was longer in the nonrefractory group (20.3 vs 9.4 years for the refractory group, HR=2.37, 95% CI 1.25‐3.52, P=.004). Conclusions Most patients with UC undergoing pouch surgery will develop pouchitis. Patients operated for nonrefractory indications have a more favourable outcome. These results may contribute to pre‐ and post‐surgical decision‐making. The findings imply that the processes determining UC severity may be similar to that causing pouchitis. Linked ContentThis article is linked to Ayubi et al and Safiri and Yanai papers. To view these articles visit https://doi.org/10.1111/apt.14255 and https://doi.org/10.1111/apt.14289.