Pouchitis

Pouchitis is an inflammatory condition affecting the ileal pouch (also called a J-pouch or ileal pouch-anal anastomosis, IPAA) that is surgically created after total proctocolectomy, most commonly performed in patients with ulcerative colitis or familial adenomatous polyposis. The ileal pouch serves as an internal reservoir for stool after the colon and rectum have been removed. Pouchitis represents the most common long-term complication following this surgery, characterized by inflammation of the mucosal lining of the pouch. The condition primarily affects the gastrointestinal system, with key symptoms including increased stool frequency, watery or bloody diarrhea, urgency, fecal incontinence, abdominal cramping, pelvic discomfort, and occasionally fever and malaise. Some patients may also experience extraintestinal manifestations such as joint pain or skin lesions. Pouchitis can present as acute (responding to a short course of treatment), relapsing (recurrent episodes), or chronic (persistent symptoms lasting more than four weeks despite standard therapy). Diagnosis is established through a combination of clinical symptoms, endoscopic findings (such as mucosal edema, ulceration, and erythema), and histological evidence of acute inflammation. The first-line treatment for acute pouchitis is antibiotic therapy, most commonly with metronidazole or ciprofloxacin. For chronic or refractory pouchitis, treatment options include prolonged or combination antibiotic courses, probiotics (such as the VSL#3 formulation for maintenance of remission), immunomodulators, corticosteroids (topical or systemic), and biologic therapies such as anti-TNF agents. The exact etiology remains unclear but is thought to involve a multifactorial interplay of genetic susceptibility, gut microbiome dysbiosis, and immune dysregulation.

Data sourced from FDA regulatory filings and ClinicalTrials.gov. Updated periodically.

Common questions about Pouchitis