Management of pouchitis: Clinical pearls for the gastroenterologist

Ileal pouch anal anastomosis (IPAA) is a surgical procedure conducted in patients with ulcerative colitis (UC) with medically refractory disease; in patients with the autosomal dominant inherited disease familial adenomatous polyposis (FAP); or in patients who have experienced dysplasia/colon cancer. The procedure aids in the management of these diseases, improves patients’ quality of life, prevents the need for a permanent stoma, and reduces the risk of colorectal cancer. A common complication from IPAA is pouchitis, which is characterized as an idiopathic non-specific inflammation within the created pouch resulting in symptoms including increased frequency of bowel movements and abdominal pain. Pouchitis is much more common in patients treated for UC (up to 60%) than in those receiving treatment for other indications (0-10%). This might be due to immune activation or dysbiosis in these patients.