The most common complication following a proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the development of pouchitis, however gaps exist in our understanding of the clinical course of pouch-related disorders. We used data from a cohort of patients from seven inflammatory bowel disease (IBD) centers in the United States to evaluate the risk factors for acute pouchitis, chronic pouchitis, and Crohn’s disease (CD) of the pouch, as well as subsequent therapy and healthcare resource utilization patterns in a longitudinal analysis.