Colon non tumor
Colitis (non-infectious)
Pouchitis

Author: Hanni Gulwani, M.D. (see Authors page)

Revised: 27 December 2016, last major update May 2013

Copyright: (c) 2003-2016, PathologyOutlines.com, Inc.

PubMed Search: colon pouchitis

Related topics: Pouch related complications
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Cite this page: Pouchitis. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/colonpouchcomplicationspouchitis.html. Accessed August 22nd, 2019.
Definition / general
  • Inflammation of ileal reservoir mucosa, associated with impaired butyrate oxidation by intestinal mucosa (Inflamm Bowel Dis 2009;15:335)
  • Late complication that occurs in 8 - 46%, no strict case definition exists
  • Nausea, vomiting, malaise, fever, abdominal pain; increased watery, foul smelling or bloody stool; often incontinence
  • Associated with appendiceal ulceration (41% of pouchitis patients vs. 0% of controls, Am J Surg Pathol 2004;28:999) and ulcerative colitis (Korean J Gastroenterol 2005;46:99)
  • May be due to altered flora of microorganisms
  • Secondary identifiable factors (20 - 30%): CMVClostridium difficile or CMV infection, collagen deposition, immune-mediated disorders, ischemia, NSAID use, radiation (Am J Gastroenterol 2010;105:51)
  • Elevated platelet count before ileal pouch-anal anastomosis for ulcerative colitis is associated with chronic pouchitis (Am Surg 2005;71:821)
Classification
  • According to Sternberg, may represent 6 different conditions:
    1. Classic pouchitis: pouch appears to be source of clinical symptoms; responds to antibiotics
    2. Proximal jejunal bacterial overgrowth: secondary to pouch distention that decreases intestinal motility; also responds to antibiotics
    3. Irritable pouch syndrome: severe clinical symptoms, but normal histology and endoscopy; may respond to fiber supplements and antidepressants
    4. Short-strip pouchitis: may be due to exacerbation of ulcerative colitis in retained rectal segments of surgical anastomoses; responds to corticosteroids
    5. Crohn disease: may present as late pouch fistula or pouchitis with granulomas; Crohn-like complications can develop in patients with ulcerative colitis after total proctocolectomy and ileal pouch-anal anastomosis (Am J Surg Pathol 1997;21:1343)
    6. Primary refractory pouchitis: excision of pouch shows no Crohn disease; cause unknown, but may be related to stasis, bacterial overgrowth, IBD related immune alterations or colonic type metaplasia; may develop dysplasia secondary to colonic-type metaplasia (Gut 1993;34:1539)
  • Pouchitis with dysplasia: associated with refractory pouchitis and colonic type metaplasia (type C below)
Case reports
Treatment
  • Initially antibiotics or possibly probiotics (Gut 2006;55:833); later steroids, sulfasalazine or pouch excision if necessary; follow patient to rule out dysplasia (Pol J Pathol 2004;55:65)
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