Management of Chronic Pouchitis

Abstract

Despite improvement and optimization in both medical therapies for ulcerative colitis, as well as endoscopy techniques to detect dysplasia, approximately 30% of UC patients still require colectomy due to refractory disease or dysplastic lesions [1]. Pouchitis, the most common complication of ileal pouch-anal anastomosis (IPAA), can be classified according to duration (acute or chronic), response to medical therapy (antibiotic responsive, dependent, or refractory) or according to etiology (idiopathic versus secondary causes) [2]. The incidence of acute pouchitis is as high as 40% during the first 12 months after ileostomy closure [3]. In contrast, patients undergoing an ileoanal pouch for polyposis syndromes have a cumulative incidence ranging from 0–10% [4, 5]. Most cases of acute pouchitis resolve after a short course of antibiotics, although over 60% are likely to relapse [6]. Furthermore, between 5–19% of patients with acute pouchitis will evolve to chronic pouchitis [7–9]. The development of chronic pouchitis significantly impacts their quality of life and is one of the leading causes of pouch failure [10, 11]. The risk of developing chronic pouchitis is also increased in UC patients with pancolitis, longer length of follow-up, concomitant primary sclerosing cholangitis, extraintestinal manifestations [2] and ex-smokers prior to colectomy [12].