Pouchitis: pathogenesis, diagnosis, and management.

The current treatment of choice for patients requiring colectomy for ulcerative colitis or familial adenomatous polyposis (FAP) is ileoanal anastomosis with pouch creation. Symptomatic inflammation of this pouch, a condition known as pouchitis, will develop in up to 40% of patients who undergo this surgery. Patients will present with crampy abdominal pain, fever, rectal bleeding, and diarrhea, and they may have either acute intermittent attacks or a chronic pouchitis syndrome. Most reported cases of pouchitis have occurred in patients with a previous history of ulcerative colitis, whereas complications develop in only a handful of patients with FAP. The etiology of pouchitis is probably a multifactorial event involving genetic, immune, microbial, and toxic mediators. The initial medical management of pouchitis usually relies on metronidazole; however, other drugs that are useful for ulcerative colitis have been found to be beneficial for pouchitis. Studying the etiology and management of pouchitis may help elucidate the pathogenesis of inflammatory bowel disease.