{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T05:24:26Z","timestamp":1786944266582,"version":"build-2736575974"},"reference-count":45,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T00:00:00Z","timestamp":1786924800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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\u2013Ottawa 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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\u20131.76), current smoking (current smokers vs. never-smokers; OR = 2.46, 95% CI: 1.28\u20134.75), primary sclerosing cholangitis (OR = 2.30, 95% CI: 1.43\u20133.72), preoperative systemic steroid use (OR = 1.61, 95% CI: 1.10\u20132.36), immunosuppressive therapy (OR = 1.32, 95% CI: 1.02\u20131.70), and extraintestinal manifestations (OR = 3.09, 95% CI: 1.65\u20135.77) 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1886122","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T04:32:38Z","timestamp":1786941158000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Risk factors for chronic pouchitis in patients with ulcerative colitis following ileal pouch-anal anastomosis: a meta-analysis"],"prefix":"10.3389","volume":"13","author":[{"given":"Zhen","family":"Meng","sequence":"first","affiliation":[{"name":"Shandong Provincial Hospital Affiliated to Shandong First Medical University","place":["Jinan, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongli","family":"Yi","sequence":"additional","affiliation":[{"name":"Shandong Provincial Hospital Affiliated to Shandong First Medical University","place":["Jinan, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuxia","family":"Yu","sequence":"additional","affiliation":[{"name":"Shandong Provincial Hospital Affiliated to Shandong First Medical University","place":["Jinan, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Chen","sequence":"additional","affiliation":[{"name":"Shandong Provincial Hospital Affiliated to Shandong First Medical University","place":["Jinan, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minhui","family":"Sun","sequence":"additional","affiliation":[{"name":"Shandong Provincial Hospital Affiliated to Shandong First Medical University","place":["Jinan, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,17]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1038\/s41392-025-02345-1","article-title":"Ulcerative colitis: signaling pathways, therapeutic targets and interventional strategies","volume":"11","author":"Jia","year":"2026","journal-title":"Signal Transduct Target Ther."},{"key":"B2","doi-asserted-by":"publisher","first-page":"251","DOI":"10.1016\/S2468-1253(23)00313-8","article-title":"Acute severe ulcerative colitis management: unanswered questions and latest insights","volume":"9","author":"Rivi\u00e8re","year":"2024","journal-title":"Lancet Gastroenterol Hepatol."},{"key":"B3","doi-asserted-by":"publisher","first-page":"826","DOI":"10.1016\/S2468-1253(21)00101-1","article-title":"Diagnosis and classification of ileal pouch disorders: consensus guidelines from the International Ileal Pouch Consortium","volume":"6","author":"Shen","year":"2021","journal-title":"Lancet Gastroenterol Hepatol."},{"key":"B4","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1016\/j.cgh.2007.11.006","article-title":"A proposed classification of ileal pouch disorders and associated complications after restorative proctocolectomy","volume":"6","author":"Shen","year":"2008","journal-title":"Clin Gastroenterol Hepatol."},{"key":"B5","doi-asserted-by":"publisher","first-page":"1575","DOI":"10.1136\/gut.2005.090316","article-title":"Threefold increased risk of infertility: a meta-analysis of infertility after ileal pouch anal anastomosis in ulcerative colitis","volume":"55","author":"Waljee","year":"2006","journal-title":"Gut."},{"key":"B6","doi-asserted-by":"publisher","first-page":"4337","DOI":"10.3390\/nu16244337","article-title":"Diet and microbiota modulation for chronic pouchitis: evidence, challenges, and opportunities","volume":"16","author":"Puca","year":"2024","journal-title":"Nutrients."},{"key":"B7","doi-asserted-by":"publisher","first-page":"2430","DOI":"10.3390\/microorganisms12122430","article-title":"Fecal microbiota transplantation for chronic pouchitis: a systematic review and meta-analysis","volume":"12","author":"Chun","year":"2024","journal-title":"Microorganisms"},{"key":"B8","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1146\/annurev-med-032224-120544","article-title":"Approach to therapy for chronic pouchitis","volume":"76","author":"Kayal","year":"2025","journal-title":"Annu Rev Med."},{"key":"B9","doi-asserted-by":"publisher","first-page":"1439","DOI":"10.14309\/ajg.0000000000000666","article-title":"An update on the medical management of inflammatory pouch complications","volume":"115","author":"Quinn","year":"2020","journal-title":"Am J Gastroenterol."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1765","DOI":"10.1002\/ueg2.70089","article-title":"Incidence and long-term outcomes of pouchitis in ulcerative colitis patients","volume":"13","author":"Bergstr\u00f8m","year":"2025","journal-title":"United Eur Gastroenterol J."},{"key":"B11","doi-asserted-by":"publisher","first-page":"4020","DOI":"10.1007\/s10620-022-07405-y","article-title":"Histopathology of colectomy specimens predicts endoscopic pouch phenotype in patients with ulcerative colitis","volume":"67","author":"Akiyama","year":"2022","journal-title":"Dig Dis Sci."},{"key":"B12","doi-asserted-by":"publisher","first-page":"705","DOI":"10.6061\/clinics\/2012(07)02","article-title":"Histopathological evaluation and risk factors related to the development of pouchitis in patients with ileal pouches for ulcerative colitis","volume":"67","author":"Arashiro","year":"2012","journal-title":"Clinics."},{"key":"B13","doi-asserted-by":"publisher","first-page":"1079","DOI":"10.1097\/MEG.0000000000000914","article-title":"Predictors of pouchitis after ileal pouch-anal anastomosis in pediatric-onset ulcerative colitis","volume":"29","author":"Rinawi","year":"2017","journal-title":"Eur J Gastroenterol Hepatol."},{"key":"B14","doi-asserted-by":"publisher","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"Bmj"},{"key":"B15","doi-asserted-by":"publisher","first-page":"603","DOI":"10.1007\/s10654-010-9491-z","article-title":"Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses","volume":"25","author":"Stang","year":"2010","journal-title":"Eur J Epidemiol."},{"key":"B16","doi-asserted-by":"publisher","first-page":"805","DOI":"10.1111\/j.1463-1318.2007.01413.x","article-title":"Predictors for acute and chronic pouchitis following restorative proctocolectomy for ulcerative colitis","volume":"10","author":"Abdelrazeq","year":"2008","journal-title":"Colorectal Dis."},{"key":"B17","doi-asserted-by":"publisher","first-page":"715","DOI":"10.1007\/s00535-025-02231-1","article-title":"Prevalence and predictability of the Chicago classification of pouchitis in ulcerative colitis: a multicenter study in Japan","volume":"60","author":"Akiyama","year":"2025","journal-title":"J Gastroenterol."},{"key":"B18","doi-asserted-by":"publisher","first-page":"388","DOI":"10.5009\/gnl240226","article-title":"Incidence, risk factors, and outcomes of chronic antibiotic-refractory pouchitis in Korean patients with ulcerative colitis","volume":"19","author":"Baek","year":"2025","journal-title":"Gut Liver."},{"key":"B19","doi-asserted-by":"publisher","first-page":"1583","DOI":"10.1016\/j.cgh.2020.06.035","article-title":"Incidence, risk factors, and outcomes of Pouchitis and pouch-related complications in patients with ulcerative colitis","volume":"19","author":"Barnes","year":"2021","journal-title":"Clin Gastroenterol Hepatol."},{"key":"B20","doi-asserted-by":"publisher","first-page":"1344","DOI":"10.1097\/DCR.0000000000001467","article-title":"Exposure to anti-tumor necrosis factor medications increases the incidence of pouchitis after restorative proctocolectomy in patients with ulcerative colitis","volume":"62","author":"Bertucci Zoccali","year":"2019","journal-title":"Dis Colon Rectum."},{"key":"B21","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1016\/j.crohns.2007.10.003","article-title":"Development of pouchitis following ileal pouch-anal anastomosis (IPAA) for ulcerative colitis: A role for serological markers and microbial pattern recognition receptor genes","volume":"2","author":"Ferrante","year":"2008","journal-title":"J Crohns Colitis."},{"key":"B22","doi-asserted-by":"publisher","first-page":"952","DOI":"10.1016\/j.cgh.2007.03.020","article-title":"A prospective multivariate analysis of clinical factors associated with pouchitis after ileal pouch-anal anastomosis","volume":"5","author":"Fleshner","year":"2007","journal-title":"Clin Gastroenterol Hepatol."},{"key":"B23","doi-asserted-by":"publisher","first-page":"2027","DOI":"10.1093\/ibd\/izy097","article-title":"Smoking and the risk of pouchitis in ulcerative colitis patients with ileal pouch-anal anastomosis","volume":"24","author":"Gorrepati","year":"2018","journal-title":"Inflamm Bowel Dis."},{"key":"B24","doi-asserted-by":"publisher","first-page":"1365","DOI":"10.1111\/j.1463-1318.2012.02993.x","article-title":"Risk factors for chronic pouchitis after ileal pouch-anal anastomosis: a prospective cohort study","volume":"14","author":"Hashavia","year":"2012","journal-title":"Colorectal Dis."},{"key":"B25","doi-asserted-by":"publisher","first-page":"1019","DOI":"10.1097\/MIB.0000000000001094","article-title":"Preoperative extraintestinal manifestations associated with chronic pouchitis in Japanese patients with ulcerative colitis after ileal pouch-anal anastomosis: a retrospective study","volume":"23","author":"Hata","year":"2017","journal-title":"Inflamm Bowel Dis."},{"key":"B26","doi-asserted-by":"publisher","first-page":"1055","DOI":"10.1080\/00365520310005938","article-title":"Patients with extraintestinal manifestations have a higher risk of developing pouchitis in ulcerative colitis: multivariate analysis","volume":"38","author":"Hata","year":"2003","journal-title":"Scand J Gastroenterol."},{"key":"B27","doi-asserted-by":"publisher","first-page":"e70267","DOI":"10.1111\/codi.70267","article-title":"Analysis of preoperative predictors for pouchitis after surgery for ulcerative colitis: a multicentre retrospective study of the clinical outcome of surgery for ulcerative colitis in Japan (COSUC study)","volume":"27","author":"Kasashima","year":"2025","journal-title":"Colorectal Dis."},{"key":"B28","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1159\/000353151","article-title":"Predictive factors for development of chronic pouchitis after ileal pouch-anal anastomosis in ulcerative colitis","volume":"88","author":"Okita","year":"2013","journal-title":"Digestion."},{"key":"B29","doi-asserted-by":"publisher","first-page":"3660","DOI":"10.1007\/s10620-020-06363-7","article-title":"Greater peripouch fat area on ct image is associated with chronic pouchitis and pouch failure in inflammatory bowel diseases patients","volume":"65","author":"Gao XH Yu","year":"2020","journal-title":"Dig Dis Sci."},{"key":"B30","doi-asserted-by":"publisher","first-page":"436","DOI":"10.1002\/bjs5.50149","article-title":"Meta-analysis of the association of extraintestinal manifestations with the development of pouchitis in patients with ulcerative colitis","volume":"3","author":"Hata","year":"2019","journal-title":"BJS Open."},{"key":"B31","doi-asserted-by":"publisher","first-page":"101226","DOI":"10.13105\/wjma.v13.i1.101226","article-title":"Risk factors associated with the development of chronic pouchitis following ileal-pouch anal anastomosis surgery for ulcerative colitis","volume":"13","author":"Khoo","year":"2025","journal-title":"World J Meta Anal."},{"key":"B32","doi-asserted-by":"publisher","first-page":"e964","DOI":"10.1016\/j.cgh.2021.02.006","article-title":"Primary sclerosing cholangitis-associated pouchitis: a distinct clinical phenotype","volume":"20","author":"Quinn","year":"2022","journal-title":"Clin Gastroenterol Hepatol."},{"key":"B33","doi-asserted-by":"publisher","first-page":"1062","DOI":"10.1093\/ibd\/izad288","article-title":"Altered bile acid and pouch microbiota composition in patients with chronic pouchitis","volume":"30","author":"Santiago","year":"2024","journal-title":"Inflamm Bowel Dis."},{"key":"B34","doi-asserted-by":"publisher","first-page":"S106","DOI":"10.1097\/DCR.0000000000003231","article-title":"Management of primary sclerosing cholangitis and extraintestinal disorders in patients with ileal pouches: a systematic review","volume":"67","author":"Shen","year":"2024","journal-title":"Dis Colon Rectum."},{"key":"B35","doi-asserted-by":"publisher","first-page":"e00670","DOI":"10.14309\/ctg.0000000000000670","article-title":"Extraintestinal manifestations and family history of inflammatory bowel disease increase the risk of pouchitis in a state-level epidemiology study","volume":"15","author":"Barnes","year":"2024","journal-title":"Clin Transl Gastroenterol."},{"key":"B36","doi-asserted-by":"publisher","first-page":"1503","DOI":"10.1111\/ans.18490","article-title":"Review of long-term complications and functional outcomes of ileoanal pouch procedures in patients with inflammatory bowel disease","volume":"93","author":"Hassan","year":"2023","journal-title":"ANZ J Surg."},{"key":"B37","doi-asserted-by":"publisher","first-page":"1519","DOI":"10.20944\/preprints202401.1510.v1","article-title":"Ustekinumab in the treatment of inflammatory bowel diseases: evolving paradigms","volume":"13","author":"Mocci","year":"2024","journal-title":"J Clin Med."},{"key":"B38","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1053\/j.gastro.2023.10.015","article-title":"AGA clinical practice guideline on the management of pouchitis and inflammatory pouch disorders","volume":"166","author":"Barnes","year":"2024","journal-title":"Gastroenterology."},{"key":"B39","doi-asserted-by":"publisher","first-page":"979","DOI":"10.3390\/medicina60060979","article-title":"Diagnosis and medical treatment of acute and chronic idiopathic pouchitis in inflammatory bowel disease","volume":"60","author":"Meianu","year":"2024","journal-title":"Medicina"},{"key":"B40","doi-asserted-by":"publisher","first-page":"17562848241249449","DOI":"10.1177\/17562848241249449","article-title":"The aetiology of pouchitis in patients with inflammatory bowel disease","volume":"17","author":"Alenzi","year":"2024","journal-title":"Ther Adv Gastroenterol."},{"key":"B41","doi-asserted-by":"publisher","first-page":"1670320","DOI":"10.3389\/fpubh.2025.1670320","article-title":"Passive smoking exposure and incidence and disease outcomes of inflammatory bowel disease: a systematic review and meta-analysis","volume":"13","author":"Mahajan","year":"2025","journal-title":"Front Public Health."},{"key":"B42","doi-asserted-by":"publisher","first-page":"806","DOI":"10.1093\/ibd\/izy003","article-title":"Peripouch fat area measured on MRI image and its association with adverse pouch outcomes","volume":"24","author":"Gao","year":"2018","journal-title":"Inflamm Bowel Dis."},{"key":"B43","doi-asserted-by":"publisher","first-page":"806","DOI":"10.1097\/MIB.0b013e31827feba5","article-title":"Chronic pouch inflammation and risk for new-onset extraintestinal cancers in patients with restorative proctocolectomy for ulcerative colitis","volume":"19","author":"Parisian","year":"2013","journal-title":"Inflamm Bowel Dis."},{"key":"B44","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1016\/j.tim.2023.08.013","article-title":"Sex shapes gut-microbiota-brain communication and disease","volume":"32","author":"Hokanson","year":"2024","journal-title":"Trends Microbiol."},{"key":"B45","doi-asserted-by":"publisher","first-page":"e20240963","DOI":"10.1590\/1806-9282.20240963","article-title":"Sex differences in a Brazilian sample of patients with inflammatory bowel disease","volume":"70","author":"Pascholatto","year":"2024","journal-title":"Rev Assoc Med Bras"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1886122\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T04:32:47Z","timestamp":1786941167000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1886122\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,17]]},"references-count":45,"alternative-id":["10.3389\/fmed.2026.1886122"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1886122","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,17]]},"article-number":"1886122"}}