Diagnosis and management of pouchitis

Pouchitis is an idiopathic inflammatory disease of the ileal reservoir in patients who have undergone IPAA. Approximately half of all UC patients who undergo this procedure will have at least 1 episode of pouchitis with approximately 15% experiencing a chronic course. PSC and other EIM increase the likelihood of developing pouchitis, whereas smoking is protective. Similar genetic and autoimmune mechanisms to UC appear to occur in an ileal reservoir that shows increasingly colon-like adaptations with respect to bacterial content and mucosal characteristics. Although most patients have a good response to antibiotic therapy, increasing evidence supports a role for probiotics in prevention and maintenance. Finally, dysplasia is a rare but real concern, and pouch surveillance guidelines must be developed.