Journal
INTESTINAL RESEARCH
Volume 19, Issue 1, Pages 1-11Publisher
KOREAN ASSOC STUDY INTESTINAL DISEASES
DOI: 10.5217/ir.2020.00047
Keywords
Pouchitis; Pouch failure; Inflammatory bowel disease; Crohn disease; Colitis, ulcerative
Categories
Funding
- NIDDK NIH HHS [P30 DK042086] Funding Source: Medline
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Patients with inflammatory bowel disease may require a restorative proctocolectomy with ileal pouch-anal anastomosis, but may develop pouchitis postoperatively. In some cases, pouch excision may be necessary, and a Crohn's disease-like phenotype may develop in a subset of patients with ulcerative colitis post-surgery.
Patients with inflammatory bowel disease (IBD) occasionally need a restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) because of medically refractory colitis or dysplasia/cancer. However, pouchitis may develop in up to 70% of patients after this procedure and significantly impair quality of life, more so if the inflammation becomes a chronic condition. About 10% of patients with IBD who develop pouchitis require pouch excision, and several risk factors of the failure have been reported. A phenotype that has features similar to Crohn's disease may develop in a subset of ulcerative colitis patients following proctocolectomy with IPAA and is the most frequent reason for pouch failure. In this review, we discuss the diagnosis and prognosis of pouchitis, risk factors for pouchitis development, and treatment options for pouchitis, including the newer biological agents.
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