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Background Total proctocolectomy (TPC) with ileal pouch anal anastomosis (IPAA) is the gold standard surgery for ulcerative colitis (UC) patients with medically refractory disease. The aim of this study was to report the rates and risk factors of inflammatory pouch conditions. Methods This was a retrospective review of UC or IBD unspecified (IBDU) patients who underwent TPC with IPAA for refractory disease or dysplasia between 2008 and 2017. Pouchoscopy data were used to calculate rates of inflammatory pouch conditions. Factors associated with outcomes in univariable analysis were investigated in multivariable analysis. Results Of the 621 patients more than 18 years of age who underwent TPC with IPAA between January 2008 and December 2017, pouchoscopy data were available for 386 patients during a median follow-up period of 4 years. Acute pouchitis occurred in 205 patients (53%), 60 of whom (30%) progressed to chronic pouchitis. Cuffitis and Crohn's disease–like condition (CDLC) of the pouch occurred in 119 (30%) patients and 46 (12%) patients, respectively. In multivariable analysis, female sex was associated with a decreased risk of acute pouchitis, and pre-operative steroid use and medically refractory disease were associated with an increased risk; IBDU was associated with chronic pouchitis; rectal cuff length ≥2 cm and medically refractory disease were associated with cuffitis; age 45–54 at colectomy was associated with CDLC. Rates of pouch failure were similar in chronic pouchitis and CDLC patients treated with biologics and those who were not. Conclusions Inflammatory pouch conditions are common. Biologic use for chronic pouchitis and CDLC does not impact the rate of pouch failure.

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DAMA has negative implications for patients including higher risks of readmission and mortality, and greater medical costs. Patients often cite poor communication with their health care team and the high financial costs of medical care as reasons for leaving against medical advice (AMA). Patients who were initially led to believe that their hospitalizations would be shorter in length were also more likely to leave AMA. 4 It is important to understand which patients are at higher risk for leaving AMA in order to create targeted interventions and potentially improve patient outcomes. Neurological disorders constitute 10.2 percent of the global burden of disease and 16.8 percent of total deaths. 5 A higher risk of DAMA has been found in patients with comorbid neurological conditions. 6 Furthermore, compared to the general population,