Approximately 30% of patients with relapsing, extensive ulcerative colitis (UC) require surgery. Total proctocolectomy with ileal pouchanal
anastomosis (IPAA) represents the most common and potentially curative surgical procedure for intractable UC since 1978, although
up to 50% of the patients undergoing surgery will develop pouchitis. Ethiopathogenesis of pouchitis is still unclear. It is thought to be
a third and distinctly different form of inflammatory bowel diseases (IBD). Since patients with UC are more likely to get pouchitis than
those with familial adenomatous polyposis, genetic predisposition and the autoimmune phenomena are susceptible in the development of the
disease. Various infections (cytomegalovirus, Candida, Clostridium difficile), ischemia, autoimmune disorders, collagen deposition and
the regular use of nonsteroidal anti-inflammatory drugs are known causative agents in the development of pouchitis, whereas the
idiopathic form of the disease is thought be the result of an abnormal mucosal immune response to altered microflora of the pouch.
Pouchitis usually responds to conventional antibiotic therapy. Refractory pouchitis develops in 5-19% of the cases and may lead to
pouch failure and excision. A recently published paper by Ferrante et al. on the efficacy of infliximab in refractory pouchitis showed
clinical response at week 10 in 82% of the patients with refractory luminal inflammation and sustained clinical response were achieved in
56% of the patients after a median follow-up of 20 months.
Last date updated on July, 2014