Primary Sclerosing Cholangitis and Colitis Leads to Increased Risk for Pouchitis

Primary sclerosing cholangitis (PSC). This chronic cholestatic liver disease is characterised by an inflammation and fibrosis of the biliary tracts.
Investigators compared rates of pouchitis and pouch failure among patients with and without primary sclerosing cholangitis.

Patients with primary sclerosing cholangitis and ulcerative colitis (PSC-UC) are more likely to experience pouchitis and pouch failure compared with UC alone, according to results from a systematic review published in the Journal of Crohn’s and Colitis.

The optimal restorative surgical management of patients with concomitant diagnoses of PSC-UC who require colectomy is controversial. These patients may be at an increased risk for pouchitis after ileal pouch-anal anastomosis (IPAA). Researchers sought to compare rates of pouchitis and pouch failure among patients with and without PSC by performing a systematic search from inception through August 18, 2020.

Twelve studies comparing the rates of pouchitis (n=11) and/or pouch failure (n=6) among patients with PSC-UC and UC alone were identified. Meta-analysis was performed using random effects modeling to estimate the odds of developing any episodes of pouchitis or pouch failure. Investigators found that a total of 4108 patients underwent an IPAA after proctocolectomy for UC, and of these, 3799 (92%) were performed for UC alone while 309 (8%) were performed for PSC-UC.

In a meta-analysis of 11 studies , however, the researchers found that patients with PSC-UC compared with UC alone were significantly more likely to develop any pouchitis (63% vs 30%; odds ratio [OR], 4.21 [95% CI, 2.86- 6.18]), chronic pouchitis (47% vs 15%; OR, 6.37 [95% CI, 3.41-11.9]) and pouch failure (10% vs 7%; OR, 1.85 [95% CI, 1.08-3.17]).

“In conclusion, we demonstrated a significantly increased risk of pouchitis among patients with PSC-UC undergoing proctocolectomy with IPAA compared with patients with UC alone,” stated the authors.

They added, “The risks of inflammatory complications after IPAA must be weighed against the potential complications with other surgical procedures, and future studies comparing outcomes among these procedures may inform decision making in this population.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Barnes EL, Holubar SD, Herfarth HH. Systematic review and meta-analysis of outcomes after ileal pouch-anal anastomosis in primary sclerosing cholangitis-ulcerative colitis. J Crohns Colitis. Published online February 5, 2021. doi: