Prevalence of Pouchitis and Patient Perception of Symptom Control and Quality of Life in an Outpatient Practice

Introduction: Pouchitis is an inflammatory condition affecting the ileal pouch in patients status post ileal pouch anal anastomosis (IPAA). This affects a significant portion of IPAA patients, though few studies have characterized the natural history of the disease and impact on quality of life. Our aim was to study the prevalence of pouchitis among currently treated outpatients, describe the disease course, and understand patients’ perspective of disease control and quality of life. Methods: We reviewed the medical charts of patients who had undergone pouchoscopy at New York University Langone Health from 2010 to 2022 and recorded demographic, clinical, and endoscopic data. We defined clinical pouchitis as 2 or more clinical symptoms at the patient’s last GI appointment and endoscopic pouchitis as “moderate” or “severe” pouchitis on the patient’s last pouchoscopy report. We also administered surveys in March 2023 to 296 patients with IPAA to understand symptom control and quality of life. Results: We identified 282 unique patients. The median age of patients was 46 (IQR 33-59), with of 54.3% males and average of 7 years (IQR 4-15) since pouch surgery. Of these, 37.2% of patients had clinical pouchitis, 36.9% had endoscopic pouchitis, and 14.9% met criteria for both. Endoscopic pouchitis was significantly associated with having a history of pouch failure (OR= 3.79, 95% CI=1.23, 11.66) and a history of chronic pouchitis (OR=3.83, 95% CI=1.88, 7.82). There was a significant association between clinical pouchitis and having ≥1 episodes of pouchitis in the last year (OR=3.06, 95% CI=1.45, 6.45) (Table 1). Of the 296 surveys sent, 74 (25%) responded. The median age of respondents was 49.5 (IQR 34-62), 59.5% were male and 91.9% were White. Majority reported poor quality of life, with ongoing symptoms of increased stool frequency (56.8%), urgency (43.2%), nighttime leakage (44.6%) and abdominal pain (23.0%). Approximately 28.4% reported taking daily antibiotics. Average treatment satisfaction score (scale of 0-10) was 6.4 and quality of life score was 5.8. Majority (64.9%) expressed interest in fecal microbiota transplant or other innovative treatments. Conclusion: Outpatients with pouchitis have high prevalence of active disease and report ongoing symptoms. The results underscore the inadequacy of current treatments and highlight the need for additional therapeutic options. Table 1. - Multivariate Statistics - Predictors of Clinical and Endoscopic Pouchitis Unadjusted Model Adjusted Model OR (95% CI) P-Value OR (95% CI) P-Value Predictors of clinical pouchitis, n = 282 History of Pouch Failure No Ref Ref Yes 0.10 (0.01, 0.74) 0.025 0.12 (0.02, 0.93) 0.043 Episodes of Pouchitis Last year No Ref Ref Yes 3.15 (1.84, 5.40) < 0.001 3.06 (1.45, 6.45) 0.003 Num Clinic Visit for IBD/Pouchitis Last Year None Ref Ref One 2.16 (1.18, 3.97) 0.013 1.45 (0.76, 2.77) 0.265 Two or More 1.81 (0.99, 3.28) 0.050 1.00 (0.48, 2.03) 0.980 Antibiotic Course Last Year No Ref Ref Yes 2.06 (1.17, 3.64) 0.012 0.96 (0.43, 2.12) 0.917 Predictors of endoscopic pouchitis, n = 282 History of Pouch Failure No Ref Ref Yes 3.39 (1.22, 9.46) 0.020 3.79 (1.23, 11.66) 0.020 History of Chronic Pouchitis No Ref Ref Yes 3.84 (1.99, 7.40) < 0.001 3.83 (1.88, 7.82) < 0.001 Num of Clinic Visit for IBD/Pouchitis Last Year None Ref Ref One 1.31 (0.70, 2.44) 0.396 1.00 (0.50, 2.01) 0.990 Two or More 2.68 (1.48, 4.83) 0.001 1.42 (0.64, 3.18) 0.388 Hosp/ER Visit for IBD or Pouchitis in Last Year No Ref Ref Yes 2.12 (1.05, 4.28) 0.037 1.42 (0.65, 3.13) 0.382 Antibiotic Course Last Year No Ref Ref Yes 1.94 (1.10, 3.42) 0.023 1.86 (0.94, 3.69) 0.075 Current Biologic Use No Ref Ref Yes 2.58 (1.51, 4.40) < 0.001 1.46 (0.76, 2.80) 0.258 OR= Odds Ratio.CI= Confidence Interval.Bolded figures indicate statistical significance (P< 0.05).