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Pouchitis is inflammation of the ileal pouch (an artificial rectum surgically created out of ileal gut tissue in patients who have undergone a colectomy), which is created in the management of patients with ulcerative colitis, indeterminate colitis, FAP, or, rarely, other colitides.
Pouchitis is an inflammation of the pelvic pouch that can result in a number of symptoms, including increased bowel movements, abdominal cramping and bloating, generalized fatigue/malaise, fever, and sometimes blood in the stools.
Overall, pouchitis is a common and often frustrating disease entity to treat. Accurate diagnosis and initial treatment with antibiotics should be undertaken. For patients with chronic pouchitis, long-term low-dose antibiotics or antibiotics followed by probiotics should be considered. In patients who continue to have problems, oral budesonide may control symptoms. In patients who continue to have refractory disease, immunosuppression or immunomodulation with 6-MP, azathioprine, or infliximab can be considered. Rarely, the patient may require resection of the ileal pouch with the creation of an end-ileostomy.