Pouchitisis an inflammation that occurs in some people who have hadileal pouch-anal anastomosis (IPAA)surgery.

This surgery is commonly called a J-pouch.

The surgery is often used to treat ulcerative colitis or other disorders that affect the colon and/or the rectum.

Pouchitis doesnt happen to everyone with a J-pouch, but it is common.

It can be a chronic problem for some people.

Pouchitis and J-Pouch Surgery

J-pouch surgery is a complex surgery usually done in two or three steps.

It is used to treatulcerative colitisand some other digestive conditions, such asfamilial adenomatous polyposis (FAP).

The first step of creating a J-pouch is the surgical removal of thelarge intestine.

This procedure is called acolectomy.

All or part of the rectum may also be removed.

In most cases, an ileostomy will be placed after the colectomy.

Anileostomyis when the end of the small intestine is brought through the abdomen, which is called a stoma.

A bag is worn over the stoma to collect stool as it leaves the body.

The ileostomy is needed to allow the newly constructed J-pouch to heal.

The result is a holding place for stool to take on the role of the removed rectum.

It is often formed in the shape of the letter J, but other shapes are sometimes used.

The second step is reversing the ileostomy to allow stool to leave the body through the bottom again.

Pouchitis

The J-pouch is made from living tissue and can be affected by diseases and conditions.

For some people, a pop in of inflammation called pouchitis can develop in the J-pouch.

Types of Pouchitis

Pouchitis was first described in 1986.

Knowledge of what causes pouchitis and its different forms has expanded over the years.

Pouchitis is now considered a spectrum, whose categories include acute, chronic, refractory, or secondary pouchitis.

What Causes Pouchitis?

Autoimmune conditions that affect the gastrointestinal system, such as ulcerative colitis, can also be a cause.

It is a complicated disorder.

Some healthcare providers may want to look at the pouch with anendoscopicprocedure before or after treating for pouchitis.

It is similar to colonoscopy but is often called a pouchoscopy by specialists.

A pouchoscopy is done in a variety of ways.

Other procedures are available that fall between these two extremes.

A healthcare provider (usually agastroenterologistor acolorectal surgeon) will give directions and do the procedure.

Some conditions may mimic pouchitis.

Adding another antibiotic, such as Xifaxan (rifaximin), might also be tried.

Pouchitis that is chronic or refractory might be treated by rotating different antibiotics.

The probiotic known as VSL#3 is and potentially prevent it from happening again.

However, it can be prohibitively expensive for some people.

If antibiotics dont work, there is less evidence and more trial and error.

The next step might be with drugs that suppress the immune system.

A throw in of steroid calledbudesonidemight be tried.

It has shown good results in some trials.

There has been little study ondietand pouchitis.

Whats the Outlook for Pouchitis?

In 80% of cases of acute pouchitis, antibiotic treatment will result in remission (symptoms stopping).

Pouch failure is when the J-pouch needs to be bypassed or removed, and a permanent ileostomy is placed.

Having chronic pouchitis may carry a 5% to 10% risk of pouch failure.

Chronic pouchitis unfortunately is linked to a risk ofcancer, although this is rare.

Studies show some differences in the potential risks.

However, the risk does seem to increase with the age of the J-pouch.

The risk at 20 years after surgery is higher than it is five years after surgery.

Biopsies will be taken to test for changes in the tissue that could indicate a risk of cancer.

Summary

Pouchitis is a common condition after having ileal pouch surgery.

Most cases of pouchitis will get better with a two- to four-week course of one or more antibiotics.

If pouchitis doesnt respond, a step-up approach to using different therapies, including biologics, might be tried.

Pouch failure and needing an ileostomy because of pouchitis is uncommon.

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