Complications: Pouchitis

Abstract

Pouchitis, especially, chronic antibiotic-refractory pouchitis, is one of the most challenging disease conditions of the ileal pouch. While the majority of pouchitis is idiopathic, secondary causes, such as the use of non-steroidal anti-inflammatory drugs (NSAID), infection of Clostridium difficile and cytomegalovirus, ischemia and obesity, should be evaluated and may be modified. Symptomatology of pouchitis is not specific, as the similar symptoms can be presented in irritable pouch syndrome, cuffitis, Crohn’s disease of the pouch. Pouchitis can be classified into microbiota-associated, autoimmune-associated, and ischemia-associated phenotypes. Pouchoscopy is the most important modality for the diagnosis and differential diagnosis of pouchitis and various pouch disorders. Oral antibiotic therapy is the main stay for the treatment of acute microbiota-associated pouchitis. Oral budesonide and immunomodulators may be effective for the treatment of autoimmune-associated pouchitis. While anti-tumor necrosis factor agents are effective in treating Crohn’s disease of the pouch, anti-integrin agents has demonstrated promising results in CARP.