What is Pouchitis?
Pouchitis is inflammation of the ileal pouch, a surgically created reservoir typically formed after removal of the colon and rectum (proctocolectomy) in patients with ulcerative colitis or familial adenomatous polyposis. It causes symptoms similar to colitis, affecting bowel function and quality of life.
What causes Pouchitis?
Causes are not fully understood but may include:
- Bacterial overgrowth or infection in the pouch
- Immune system response or autoimmune factors
- Poor blood supply to the pouch
- Changes in the gut microbiome
- Use of antibiotics or medications affecting bowel flora
What are the symptoms?
Symptoms often develop suddenly or gradually and include:
- Increased stool frequency and urgency
- Abdominal cramps and pain
- Diarrhea, sometimes with blood or mucus
- Fatigue and malaise
- Fever in some cases
- Leakage or incontinence
- Nausea or loss of appetite
How is Pouchitis diagnosed?
Diagnosis involves:
- Clinical evaluation of symptoms
- Endoscopy (pouchoscopy) to visualize inflammation in the pouch
- Biopsy during endoscopy to confirm inflammation
- Stool tests to rule out infections
- Blood tests to assess inflammation markers
How is it treated?
Treatment aims to reduce inflammation and control symptoms:
- Antibiotics: Most commonly used treatment (e.g., metronidazole, ciprofloxacin)
- Probiotics to restore healthy gut bacteria
- Anti-inflammatory medications in some cases
- Dietary adjustments to reduce irritation
- Surgery may be needed in severe or recurrent cases
What is the prognosis?
With prompt treatment, many patients recover fully. Some may experience recurrent or chronic pouchitis requiring ongoing management.
What complications can occur?
- Chronic inflammation leading to pouch dysfunction
- Pouch failure requiring surgical revision or removal
- Abscess or fistula formation in severe cases
Who is most at risk?
- Patients who have undergone ileal pouch-anal anastomosis (IPAA) surgery
- Those with a history of ulcerative colitis
- Individuals with altered gut microbiota or immune system changes
Can Pouchitis be prevented?
Prevention strategies include:
- Maintaining good pouch hygiene
- Avoiding unnecessary antibiotics that disrupt gut flora
- Using probiotics as advised by healthcare providers
- Regular follow-up after IPAA surgery to detect early signs
Are there support resources?
Yes, support includes:
- Gastroenterologists specializing in inflammatory bowel disease (IBD)
- Dietitians for nutritional guidance
- Patient support groups for pouchitis and IBD
- Resources from organizations such as the Crohn’s & Colitis Foundation