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Review
. 2021 Jan;19(1):1-11.
doi: 10.5217/ir.2020.00047. Epub 2020 Nov 5.

Pouchitis in inflammatory bowel disease: a review of diagnosis, prognosis, and treatment

Shintaro Akiyama  1 , Victoria Rai  1 , David T Rubin  1
Affiliations
Review

Pouchitis in inflammatory bowel disease: a review of diagnosis, prognosis, and treatment

Shintaro Akiyama et al. Intest Res. 2021 Jan.

Abstract

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.

Keywords: Colitis, ulcerative; Crohn disease; Inflammatory bowel disease; Pouch failure; Pouchitis.

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Conflict of interest statement

Conflict of Interest

Rubin DT has received grant support from Takeda, and has served as a consultant for Abbvie, Abgenomics, Allergan Inc., Boehringer Ingelheim Ltd., Bristol-Myers Squibb, Celgene Corp/Syneos, Check-cap, Dizal Pharmaceuticals, GalenPharma/Atlantica, Genentech/Roche, Gilead Sciences, Ichnos Sciences S.A., GlaxoSmithKline Services, Janssen Pharmaceuticals, Lilly, Narrow River Mgmt, Pfizer, Prometheus Laboratories, Reistone, Shire, Takeda, and Techlab Inc. Akiyama S and Rai V report no conflicts of interest.

Rubin DT is an editorial board member of the journal but did not involve in the peer reviewer selection, evaluation, or decision process of this article. No other potential conflicts of interest relevant to this article were reported.

Figures

Fig. 1.
Fig. 1.
Diagnostic strategy for pouchitis. aPouchitis disease activity index (PDAI) includes these variables. IPAA, ileal pouch-anal anastomosis; CMV, cytomegalovirus; C. difficile, Clostridioides difficile; PCR, polymerase chain reaction; MRI, magnetic resonance imaging; IgG4, immunoglobulin G4, pANCA, perinuclear antineutrophil cytoplasmic antibody.
Fig. 2.
Fig. 2.
Schema of the J pouch.
Fig. 3.
Fig. 3.
Treatment strategy for pouchitis. PO, per os; 5-ASA, 5-aminosalicylic acid; TNF, tumor necrosis factor.
See this image and copyright information in PMC

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