Restorative proctocolectomy with
ileal pouch-anal anastomosis (IPAA) has become the surgical treatment of choice for patients with medically refractory
ulcerative colitis (UC) or UC with dysplasia and for the majority of patients with
familial adenomatous polyposis. However, UC patients with IPAA are susceptible to a number of inflammatory and non-inflammatory sequelae, such as
pouchitis,
Crohn disease(CD) of the pouch, cuffitis, and irritable pouch syndrome, in addition to common surgery-associated complications, which adversely affect the surgical outcome and compromise patient's health-related quality of life.
Pouchitis is the most frequent long-term complication of IPAA in patients with UC, with a cumulative prevalence of up to 50%.
Pouchitis may be classified based on the etiopathogenesis into "idiopathic" and "secondary" types and the management is often different. Pouchoscopy is the most important tool for the diagnosis and differential diagnosis in patients with pouch dysfunction.
Antibiotic therapy is the main stay of treatment for active
pouchitis. Some patients may develop dependency on
antibiotics, requiring long-term maintenance
therapy. While management of
antibiotic-dependent or
antibiotic-refractory
pouchitis has been challenging, secondary etiology for
pouchitis should be evaluated and modified, if possible.