Pouchitis
- Pouchitis, one of the most frequent long-term complications of IPAA, is a nonspecific acute or chronic inflammation of the reservoir.
- Pouchitis is found in 7% to 44% of patients with IPAA; it presents with watery, bloody stools, urgency, frequency, abdominal pain, fever, malaise, and possible exacerbation of extra-intestinal manifestations of inflammatory bowel disease.
- The cause is uncertain, but the risk is greater in chronic ulcerative colitis than in familial polyposis.
- Pouch stasis, bacterial overgrowth, dysbiosis, ischemia, pelvic sepsis, oxygen-derived free radicals, altered immune status, and lack of mucosal trophic factors have been proposed as etiologic factors.
How is pouchitis treated?
- Successful treatment regimens include metronidazole and other antianaerobic antibiotics as well as steroid or 5-aminosalicylate enemas. Topical volatile fatty acids and glutamine have been used with variable success.
- Maintenance with the probiotic VSL#3 has been reported to help prevent recurrences.
- Although half of patients with pouchitis at some time suffer a recurrence, very few develop intractable involvement requiring pouch excision.
