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Review

Pouchitis: Clinical Features, Diagnosis, and Treatment

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Pages 3871-3879 | Published online: 24 Jul 2021

References

  • Fazio VW, Ziv Y, Church JM, et al. Ileal pouch-anal anastomoses complications and function in 1005 patients. Ann Surg. 1995;222:120–127. doi:10.1097/00000658-199508000-00003
  • Gionchetti P, Dignass A, Danese S, et al. 3rd European evidence-based consensus on the diagnosis and management of crohn’s disease 2016: part 2: surgical management and special situations. J Crohns Colitis. 2017;11(2):135–149. doi:10.1093/ecco-jcc/jjw169
  • Li Y, Shen B. Evaluating Pouch Problems. Gastroenterol Clin N Am. 2012;41:355–378. doi:10.1016/j.gtc.2012.01.013
  • Sandborn WJ. Pouchitis following ileal pouch-anal anastomosis: definition, pathogenesis, and treatment. Gastroenterology. 1994;107:1856–1860. doi:10.1016/0016-5085(94)90832-x
  • Magro F, Gionchetti P, Eliakim R, et al. Third European evidence-based consensus on diagnosis and management of ulcerative colitis. part 1: definitions, diagnosis, extra-intestinal manifestations, pregnancy, cancer surveillance, surgery, and ileo-anal pouch disorders. J Crohn’s Colitis. 2017:649–670. doi:10.1093/ecco-jcc/jjx008
  • Magro F, Lopes S, Rodrigues S, Azevedo I. How to manage pouchitis in ulcerative colitis? Curr Drug Targets. 2011;12:1454–1461. doi:10.2174/1389450011796818144
  • Hurst RD, Molinari M, Chung TP, Rubin M, Michelassi F. Prospective study of the incidence, timing and treatment of pouchitis in 104 consecutive patients after restorative proctocolectomy. Arch Surg. 1996;131:497–500. doi:10.1001/archsurg.1996.01430170043007
  • Meagher AP, Farouk R, Dozois RR, Kelly KA, Pemberton JH. J ileal pouch-anal anastomosis for chronic ulcerative colitis: complications and long-term outcome in 1310 patients. Br J Surg. 1998;85:800–803. doi:10.1046/j.1365.2168.1998.00589.x
  • Simchuk EJ, Thirlby RC. Risk factors and true incidence of pouchitis in patients after ileal pouch-anal anastomoses. World J Surg. 2000;24:851–856. doi:10.1007/s002680010136
  • Penna C, Dozois R, Tremaine W, et al. Pouchitis after ileal pouch-anal anastomosis for ulcerative colitis occurs with increased frequency in patients with associated primary sclerosing cholangitis. Gut. 1996;38:234–239. doi:10.1136/gut.38.2.234
  • Shen B, Fazio VW, Remzi FH, et al. Comprehensive evaluation of inflammatory and noninflammatory sequelae of ileal pouch-anal anastomoses. Am J Gastroenterol. 2005;100:93–101. doi:10.1111/j.1572-0241.2005.40778.x
  • Stahlberg D, Gullberg K, Liljeqvist L, Hellers G, Lofberg R. Pouchitis following pelvic pouch operation for ulcerative colitis. Incidence, cumulative risk, and risk factors. Dis Colon Rectum. 1996;39:1012–1018. doi:10.1007/BF02054692
  • Svaninger G, Nordgren S, Oresland T, Hulten L. Incidence and characteristics of pouchitis in the Kock continent ileostomy and the pelvic pouch. Scand J Gastroenterol. 1993;28:695–700. doi:10.3109/00365529309098275
  • Landy J, Al-Hassi HO, McLaughlin SD, et al. Etiology of pouchitis. Inflamm Bowel Dis. 2012;18:1146–1155. doi:10.1002/ibd.21911
  • Batista D, Raffals L. Role of intestinal bacteria in the pathogenesis of pouchitis. Inflamm Bowel Dis. 2014;20:1481–1486. doi:10.1097/MIB.0000000000000055
  • Nicholls RJ, Belliveau P, Neill M, Wilks M, Tabaqchali S. Restorative proctocolectomy with ileal reservoir: a pathophysiological assessment. Gut. 1981;22:462–468. doi:10.1136/gut.22.6.462
  • Santavirta J, Mattila J, Kokki M, Matikainen M. Mucosal morphology and fecal bacteriology after ileoanal anastomosis. Int J Colorectal Dis. 1991;6:38–41. doi:10.1007/BF00703959
  • Ruseler-van Embden JG, Schouten WR, van Lieshout LM. Pouchitis: result of microbial imbalance? Gut. 1994;35:658–664. doi:10.1136/gut.35.5.658
  • Meier CB, Hegazi RA, Aisenberg J, et al. Innate immune receptor genetic polymorphisms in pouchitis: is CARD15 a susceptibility factor? Inflamm Bowel Dis. 2005;11(11):965–971. doi:10.1097/01.mib.0000186407.25694.cf
  • Tyler AD, Milgrom R, Stempak JM, et al. The NOD2insC polymorphismis associated with worse outcome following ileal pouch-anal anastomosis for ulcerative colitis. Gut. 2013;62:1433. doi:10.1136/gutjnl-2011-301957
  • Carter MJ, Di Giovine FS, Cox A, et al. The interleukin 1 receptor antagonist gene allele 2 as a predictor of pouchitis following colectomy and IPAA in ulcerative colitis. Gastroenterology. 2001;121:805–811. doi:10.1053/gast.2001.28017
  • Lammers KM, Ouburg S, Morre SA, et al. Combined carriership of TLR9-1237C and CD14-260T alleles enhances the risk of developing chronic relapsing pouchitis. World J Gastroenterol. 2005;11:7323–7329. doi:10.3748/wjg.v11.i46.7323
  • Merrett MN, Mortensen N, Kettlewell M, Jewell DO. Smoking may prevent pouchitis in patients with restorative proctocolectomy for ulcerative colitis. Gut. 1996;38:362–364. doi:10.1136/gut.38.3.362
  • Schmidt CM, Lazenby AJ, Hendrickson RJ, Sitzmann JV. Preoperative terminal ileal and colonic resection histopathology predicts risk of pouchitis in patients after ileoanal pull-through procedure. Ann Surg. 1998;227:654–662. doi:10.1097/00000658-199805000-00006
  • Shepherd NA, Hulten L, Tytgat GN, et al. Pouchitis. Int J Colorectal Dis. 1989;4:205–229. doi:10.1007/BF01644986
  • Lohmuller JL, Pemberton JH, Dozois RR, Ilstrup D, van Heerden J. Pouchitis and extraintestinal manifestations of inflammatory bowel disease after ileal pouch-anal anastomosis. Ann Surg. 1990;211:622–627.
  • Shen B, Fazio VW, Remzi FH, et al. Effect of withdrawal of nonsteroidal anti-inflammatory drug use on ileal pouch disorders. Dig Dis Sci. 2007;52:3321–3328. doi:10.1007/s10620-006-9710-3
  • Achkar JP, Al-Haddad M, Lashner B, et al. Differentiating risk factors for acute and chronic pouchitis. Clin Gastroenterol Hepatol. 2005;3:60–66. doi:10.1016/s1542-3565(04)00604-4
  • Shen B, Remzi FH, Nutter B, et al. Association between immune-associated disorders and adverse outcomes of ileal pouch-anal anastomosis. Am J Gastroenterol. 2009;104:655–664. doi:10.1038/ajg.2008.76
  • Sagar PM, Taylor BA. Pelvic ileal reservoirs: the options. Br J Surg. 1994;81:325–332. doi:10.1002/bjs.1800810304
  • Pardi DS, D’Haens G, Shen B, Campbell S, Gionchetti P. Clinical guidelines for the management of pouchitis. Inflamm Bowel Dis. 2009;15:1424–1431. doi:10.1002/ibd.21039
  • Pardi DS, Sandborn WJ. Systematic review: the management of pouchitis. Aliment Pharmacol Ther. 2006;23:1087–1096. doi:10.1111/j.1365-2036.2006.02884.x
  • Shen B, Lashner BA, Bennett AE, et al. Treatment of rectal cuff inflammation (cuffitis) in patients with ulcerative colitis following restorative proctocolectomy and ileal pouch-anal anastomosis. Am J Gastroenterol. 2004;99:1527–1531. doi:10.1111/j.1572-0241.2004.30518.x
  • Shen B, Fazio VW, Remzi FH, et al. Clinical features and quality of life in patients with different phenotypes of Crohn’s disease of the ileal pouch. Dis Colon Rectum. 2007;50:1450–1459. doi:10.1007/s10350-007-0284-8
  • Shen B. Crohn’s disease of the pouch: reality, diagnosis, and management. Inflamm Bowel Dis. 2009;15:284–294. doi:10.1002/ibd.20661
  • Lightner AL, Fletcher JG, Pemberton JH, Mathis KL, Raffals LE, Smyrk T. Crohn’s Disease of the Pouch: a true diagnosis or an oversubscribed diagnosis of exclusion? Dis Colon Rectum. 2017;60(11):1201–1208. doi:10.1097/DCR.0000000000000918
  • Shen B, Achkar JP, Lashner BA, et al. Irritable pouch syndrome: a new category of diagnosis for symptomatic patients with ileal pouch-anal anastomosis. Am J Gastroenterol. 2002;97:972–977. doi:10.1111/j.1572-0241.2002.05617.x
  • Shen B. Acute and chronic pouchitis—pathogenesis, diagnosis and treatment. Nat Rev Gastroenterol Hepatol. 2012;9:323–333. doi:10.1038/nrgastro.2012.58
  • Shen B. Pouchitis: what Every Gastroenterologist Needs to Know. Clin Gastroenterol Hepatol. 2013;11:1538–1549. doi:10.1016/j.cgh.2013.03.033
  • Navaneethan U, Shen B. Secondary Pouchitis: those With Identifiable Etiopathogenetic or Triggering Factors. Am J Gastroenterol. 2010;105:51–64. doi:10.1038/ajg.2009.530
  • Shen B, Plesec TP, Remer E, et al. Asymmetric endoscopic inflammation of the ileal pouch: a sign of ischemic pouchitis? Inflamm Bowel Dis. 2012;16:836–846. doi:10.1002/ibd.21129
  • Hercun J, Côté-Daigneault J, Lahaie RG, Richard C, Wassef R, Poitras P. Crohn’s Disease after Proctocolectomy and Ileal Pouch Anal Anastomosis for Ulcerative Colitis. Dis Colon Rectum Dec. 2020. doi:10.1097/DCR.0000000000001721
  • Li Y, Qian J, Queener E, Shen B. Risk factors and outcome of PCR-detected Clostridium difficile infection in ileal pouch patients. Inflamm Bowel Dis. 2013;19:397–403. doi:10.1097/MIB.0b013e318280fcb9
  • Seril DN, Ashburn JH, Lian L, Shen B. Risk Factors and Management of Refractory or Recurrent Clostridium difficile Infection in Ileal Pouch Patients. Inflamm Bowel Dis. 2014;20:378–388. doi:10.1097/MIB.0000000000000205
  • Ardalan ZS, Sparrow MP. A Personalized Approach to Managing Patients With an IlealPouch-Anal Anastomosis. Front Med. 2020;337:1–20. doi:10.3389/fmed.2019.00337
  • Shen B, Achkar JP, Lashner BA, et al. Endoscopic and histologic evaluation together with symptom assessment are required to diagnose pouchitis. Gastroenterology. 2001;121:261–267. doi:10.1053/gast.2001.26290
  • Moskowitz RL, Shepherd NA, Nicholls RJ. An assessment of inflammation in the reservoir after restorative proctocolectomy with ileoanal ileal reservoir. Int J Colorectal Dis. 1986;1:167–174. doi:10.1007/BF01648445
  • Mahadevan U, Sandborn WJ. Diagnosis and management of pouchitis. Gastroenterology. 2003;124:1636–1650. doi:10.1016/s0016-5085(03)00325-1
  • Shen B, Achkar JP, Connor JT, et al. Modified pouchitis disease activity index: a simplified approach to the diagnosis of pouchitis. Dis Colon Rectum. 2003;46:748–753. doi:10.1007/s10350-004-6652-8
  • Samaan MA, Shen B, Mosli MH, et al. Reliability among central readers in the evaluation of endoscopic disease activity in pouchitis. Gastrointest Endosc. 2018;88:360–369. doi:10.1016/j.gie.2018.04.2330
  • Zhu H, Wu XR, Queener E, Kiran RP, Remzi FH, Shen B. Clinical value of surveillance pouchoscopy in asymptomatic ileal pouch patients with underlying inflammatory bowel disease. Surg Endosc. 2013;27:4325–4332. doi:10.1007/s00464-013-3054-9
  • Kayal M, Plietz M, Radcliffe M, et al. Endoscopic Activity In Asymptomatic Patients With An Ileal Pouch Is Associated With An Increased Risk of Pouchitis. Aliment Pharmacol Ther. 2019;50:1189–1194. doi:10.1111/apt.15505
  • Samaan MA, de Jong D, Sahami S, et al. Incidence and severity of prepouch ileitis: a distinct disease entity or a manifestation of refractory pouchitis? Inflamm Bowel Dis. 2016;22:662–668. doi:10.1097/MIB.0000000000000593
  • Rottoli M, Vallicelli C, Bigonzi E, et al. Prepouch ileitis after ileal pouch-anal anastomosis: patterns of presentation and risk factors for failure of treatment. J Crohns Colitis. 2018;12:273–279. doi:10.1093/ecco-jcc/jjx140
  • Setti Carraro PG, Talbot IC, Nicholls JR. Patterns of distribution of endoscopic and histological changes in the ileal reservoir after restorative proctocolectomy for ulcerative colitis. A long-term follow-up study. Int J Colorectal Dis. 1998;13:103–107. doi:10.1007/s003840050144
  • Tulchinsky H, Hawley PR, Nicholls J. Long-term failure after restorative proctocolectomy for ulcerative colitis. Ann. 2003;238:229–234. doi:10.1097/01.sla.0000082121.84763.4c
  • Belliveau P, Trudel J, Vasilevsky CA, Stein B, Gordon PH. Ileoanal anastomosis with reservoirs: complications and long-term results. Can J Surg. 1999;42:345–352.
  • Hurst RD, Chung TP, Rubin M, Michelassi F. Implications of acute pouchitis on the long-term functional results after restorative proctocolectomy. Inflamm Bowel Dis. 1998;4:280–284. doi:10.1002/ibd.3780040405
  • Shen B, Achkar JP, Lashner BA, et al. A randomized trial of ciprofloxacin and metronidazole in treating acute pouchitis. Inflamm Bowel Dis. 2001;7:301–305. doi:10.1097/00054725-200111000-00004
  • Sambuelli A, Boerr L, Negreira S. Budesonide enema in pouchitis. A double-blind, double-dummy, controlledtrial. Aliment Pharmacol Ther. 2002;16:27–34. doi:10.1046/j.1365-2036.2002.01139.x
  • Isaacs KL, Sandler RS, Abreu M, et al. Rifaximin for the treatment of active pouchitis: a randomized, double-blind, placebo-controlled pilot study. Inflamm Bowel Dis. 2007;13:1250. doi:10.1002/ibd.20187
  • Kuisma J, Mentuls S, Jarvinen H, Kahri A, Saxelin M, Farkkila M. Effect of lactobacillus rhamnosus GG on ileal pouch inflammation and microbial flora. Aliment Pharmacol Ther. 2003;17:509–515. doi:10.1046/j.1365-2036.2003.01465.x
  • Gionchetti P, Rizzello F, Morselli C, et al. High-dose probiotics for the treatment of active pouchitis. Dis Colon Rectum. 2007;50:2075–2084. doi:10.1007/s10350-007-9068-4
  • Gionchetti P, Rizzello F, Helwig U, et al. Prophylaxis of pouchitis onset with probiotic therapy: a double‐blind placebo controlled trial. Gastroenterology. 2003;124:1202–1209. doi:10.1016/s0016-5085(03)00171-9
  • Gosselink MP, Schouten WR, van Lieshout LMC, Hop WCJ, Laman JD, Ruseler-van Embden JGH. Delay of the first onset of pouchitis by oral intake of the probiotic strain Lactobacillus rhamnosus GG. Dis Colon Rectum. 2004;47:876–884. doi:10.1007/s10350-004-0525-z
  • Ha CY, Bauer JJ, Lazarev M, et al. Early institution of tinidazole may prevent pouchitis following ileal pouch-anal anastomosis (IPAA) surgery in ulcerative colitis (UC) patients. Gastroenterology. 2010;138(5 Suppl 1):S69. doi:10.1016/S0016-5085(10)60314-9
  • Gionchetti P, Rizzello F, Venturi A, et al. Oral bacteriotherapy as maintenance treatment in patients with chronic pouchitis: a double-blind, placebo-controlled trial. Gastroenterology. 2000;119:305–309. doi:10.1053/gast.2000.9370
  • Mimura T, Rizzello F, Helwig U, et al. Once daily high dose probiotic therapy for maintaining remission in recurrent or refractory pouchitis. Gut. 2004;53:108–114. doi:10.1136/gut.53.1.108
  • Segal JP, Poo SX, McLaughlin SD, Faiz OD, Clark SK, Hart AL. Long term follow-up of the use of maintenance antibiotic therapy for chronic antibiotic-dependent pouchitis. Frontline Gastroenterol. 2018;9:154–158. doi:10.1136/flgastro-2017-100913
  • Lavryk OA, Stocchi L, Shawki S, et al. Redo IPAA After a Failed Pouch In Patients With Crohn’s Disease: is It Worth Trying? Dis Colon Rectum. 2020;63:823–830. doi:10.1097/DCR.0000000000001644
  • Gionchetti P, Rizzello F, Venturi A, et al. Antibiotic combination therapy in patients with chronic treatment-resistant pouchitis. Aliment Pharmacol Ther. 1999;13:713–718. doi:10.1046/j.1365-2036.1999.00553.x
  • Abdelrazeq AS, Kelly SM, Lund JN, Leveson SH. Rifaximin–ciprofloxacin combination therapy is effective in chronic active refractory pouchitis. Colorectal Dis. 2005;7:182–186. doi:10.1111/j.1463-1318.2004.00746.x
  • Mimura T, Rizzello F, Helwig U, et al. Four-week open-label trial of metronidazole and ciprofloxacin for the treatment of recurrent or refractory pouchitis. Aliment Pharmacol Ther. 2002;16:909–917. doi:10.1046/j.1365-2036.2002.01203.x
  • Shen B, Fazio VW, Remzi FH, et al. Combined ciprofloxacin and tinidazole in the treatment of chronic refractory pouchitis. Dis Colon Rectum. 2007;50:498–508. doi:10.1007/s10350-006-0828-3
  • Gionchetti P, Rizzello F, Poggioli G, et al. Oral budesonide in the treatment of chronic refractory pouchitis. Aliment Pharmacol Ther. 2007;25:1231–1236. doi:10.1111/j.1365-2036.2007.03306.x
  • Gionchetti P, Calabrese C, Calafiore A, et al. Oral beclomethasone dipropionate in chronic refractory pouchitis. J Crohn's Colitis. 2014;8:649–653. doi:10.1016/j.crohns.2013.12.001
  • Uchino M, Ikeuchi H, Matsuoka H, et al. Topical tacrolimus therapy for antibiotic-refractory pouchitis. Dis Colon Rectum. 2013;56:1166–1173. doi:10.1097/DCR.0b013e31829ebd83
  • Huguet M, Pereira B, Goutte M, Goutorbe F, Dubois A, Bommelaer G. Systematic review with meta-analysis: anti-TNF therapy inrefractory pouchitis and Crohn’s disease-like complications of the pouch after ileal pouch-anal anastomosis following colectomy for ulcerative colitis. Inflamm Bowel Dis. 2018;24:261–268. doi:10.1093/ibd/izx049
  • Gregory M, Weaver KN, Hoversten P, et al. Efficacy of Vedolizumab for Refractory Pouchitis of the Ileo-anal Pouch: results From a Multicenter US Cohort. Inflamm Bowel Dis. 2019;25:1569–1576. doi:10.1093/ibd/izz030
  • Singh A, Khan F, Lopez R, Shen B, Philpott J. Vedolizumab for chronic antibiotic-refractory pouchitis. Gastroenterol Rep. 2019;7:121–126. doi:10.1093/gastro/goz001
  • Ribaldone DG, Pellicano R, Saracco GM, Morino M, Astegiano M. Vedolizumab for treatment of chronic refractory pouchitis: a systematic review with pool analysis. Rev Esp Enferm Dig. 2020;112:59–63. doi:10.17235/reed.2019.6336/2019
  • Ollech JE, Rubin DT, Glick L, et al. Ustekinumab Is Effective for the Treatment of Chronic Antibiotic-Refractory Pouchitis. Dig Dis Sci. 2019;64:3596–3601. doi:10.1007/s10620-019-05697-1