Management of Pouchitis and Other Common Complications of the Pouch

Dalal RL1, Shen B2, Schwartz DA1. Inflamm Bowel Dis. 2018 Apr 23;24(5):989-996. doi: 10.1093/ibd/izy020.

Author information

1 Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee.

2 Department of Gastroenterology/Hepatology, the Cleveland Clinic, Foundation, Cleveland, Ohio.


Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) has become the preferred surgical treatment for refractory or complicated ulcerative colitis (UC) and familial adenomatous polyposis (FAP). Pouchitis is the most common complication of this procedure and can occur in about 50% of patients. Treatment of pouchitis depends on the phenotype of disease. Pouchitis can be classified as acute, chronic/refractory, or secondary pouchitis, which includes pouchitis occurring due to Crohn's disease (CD). CD of the pouch is becoming an increasingly recognized problem, and management is challenging. This article reviews the literature and offers treatment recommendations regarding management of pouchitis and CD of the pouch.

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