Editorial
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 7, 2015; 21(29): 8739-8752
Published online Aug 7, 2015. doi: 10.3748/wjg.v21.i29.8739
Inflammatory pouch disease: The spectrum of pouchitis
Petros Zezos, Fred Saibil
Petros Zezos, Fred Saibil, Division of Gastroenterology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario M4N 3M5, Canada
Author contributions: Zezos P and Saibil F substantial contributions to conception and design, acquisition of data; analysis and interpretation of data, drafting the article or revising it critically for important intellectual content; and final approval of the version to be published.
Supported by unrestricted grants from Janssen Inc. (Canada), Abbvie (Canada), Ferring Canada Inc., and Actavis Canada Inc. (partly, to Dr Zezos).
Conflict-of-interest statement: The authors declare no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Petros Zezos, MD, PhD, Division of Gastroenterology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, H52-2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada. zezosp13@hotmail.com
Telephone: +1-416-4804727 Fax: +1-416-4805977
Received: March 4, 2015
Peer-review started: March 5, 2015
First decision: April 13, 2015
Revised: April 29, 2015
Accepted: June 26, 2015
Article in press: June 26, 2015
Published online: August 7, 2015
Processing time: 157 Days and 4.3 Hours
Abstract

Restorative proctocolectomy with ileal-pouch anal anastomosis (IPAA) is the operation of choice for medically refractory ulcerative colitis (UC), for UC with dysplasia, and for familial adenomatous polyposis (FAP). IPAA can be a treatment option for selected patients with Crohn’s colitis without perianal and/or small bowel disease. The term “pouchitis” refers to nonspecific inflammation of the pouch and is a common complication in patients with IPAA; it occurs more often in UC patients than in FAP patients. This suggests that the pathogenetic background of UC may contribute significantly to the development of pouchitis. The symptoms of pouchitis are many, and can include increased bowel frequency, urgency, tenesmus, incontinence, nocturnal seepage, rectal bleeding, abdominal cramps, and pelvic discomfort. The diagnosis of pouchitis is based on the presence of symptoms together with endoscopic and histological evidence of inflammation of the pouch. However, “pouchitis” is a general term representing a wide spectrum of diseases and conditions, which can emerge in the pouch. Based on the etiology we can sub-divide pouchitis into 2 groups: idiopathic and secondary. In idiopathic pouchitis the etiology and pathogenesis are still unclear, while in secondary pouchitis there is an association with a specific causative or pathogenetic factor. Secondary pouchitis can occur in up to 30% of cases and can be classified as infectious, ischemic, non-steroidal anti-inflammatory drugs-induced, collagenous, autoimmune-associated, or Crohn’s disease. Sometimes, cuffitis or irritable pouch syndrome can be misdiagnosed as pouchitis. Furthermore, idiopathic pouchitis itself can be sub-classified into types based on the clinical pattern, presentation, and responsiveness to antibiotic treatment. Treatment differs among the various forms of pouchitis. Therefore, it is important to establish the correct diagnosis in order to select the appropriate treatment and further management. In this editorial, we present the spectrum of pouchitis and the specific features related to the diagnosis and treatment of the various forms.

Keywords: Pouchitis; Idiopathic pouchitis; Secondary pouchitis; Ulcerative colitis, Crohn’s disease

Core tip: Proctocolectomy with ileal-pouch and anal anastomosis is the operation of choice for refractory ulcerative colitis, for colitis with dysplasia, for familial polyposis and for selected Crohn’s colitis patients. Pouchitis symptoms are non-specific, and cannot be used alone to identify the cause. Furthermore, the name “pouchitis” is a general term representing many conditions, with differing causes and treatments. To manage pouchitis appropriately, one must be able to establish the correct diagnosis. In this paper, we have reviewed the diagnostic methods, including endoscopy, histology and other investigative tools, with the goal of being able to provide the correct diagnosis and treatment.