Fact-checked by Grok 2 weeks ago

Pouchitis

Pouchitis is a nonspecific inflammatory condition of the ileal pouch, an artificial reservoir surgically created from the small intestine (ileum) and connected to the anus via ileal pouch-anal anastomosis (IPAA), most commonly performed after colectomy for ulcerative colitis or other inflammatory bowel diseases. It represents the most frequent long-term complication of this restorative proctocolectomy procedure, affecting up to 50% of patients within 10 years postoperatively, with acute episodes often emerging within the first year after surgery.^[1]^[2] The condition manifests through a range of gastrointestinal symptoms, including increased stool frequency, abdominal cramping, urgency, rectal bleeding, tenesmus (a sensation of incomplete evacuation), and nocturnal fecal seepage, which can significantly impair quality of life. Systemic signs such as fever, joint pain, and malaise may also occur, particularly in severe or chronic cases. Pouchitis is classified as acute if symptoms last ≤4 weeks or chronic if >4 weeks, with subtypes including antibiotic-responsive, recurrent, or refractory forms that do not resolve with standard therapy.^[1]^[2] The pathogenesis of pouchitis remains multifactorial and incompletely understood, involving dysbiosis of the gut microbiota, an aberrant immune response similar to that in ulcerative colitis, and exposure to the fecal stream post-surgery. Key risk factors include a history of extensive ulcerative colitis, backwash ileitis, primary sclerosing cholangitis, nonsmoking status, and use of nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen. Secondary causes, such as infections (e.g., Clostridium difficile) or Crohn's disease-like changes in the pouch, must be excluded to confirm idiopathic pouchitis.^[1]^[2] Diagnosis relies on a combination of clinical symptoms, endoscopic evaluation via pouchoscopy showing mucosal erythema, edema, friability, or ulceration, and histological confirmation from biopsies demonstrating acute inflammation with neutrophil infiltration. The Pouchitis Disease Activity Index (PDAI), which scores symptoms, endoscopy, and histology, is used for objective assessment, with a score ≥7 indicating active disease.^[1] As outlined in the 2024 American Gastroenterological Association (AGA) Clinical Practice Guideline, treatment for acute episodes typically involves antibiotics such as ciprofloxacin or metronidazole for 2–4 weeks, achieving response in most cases. For chronic antibiotic-dependent pouchitis, chronic antibiotics or advanced therapies like vedolizumab may be used; chronic antibiotic-refractory pouchitis often requires biologics such as vedolizumab or anti-TNF agents, or short-term corticosteroids like budesonide. Probiotics (e.g., VSL#3 or De Simone formulation) are suggested for secondary prevention of recurrence in patients responsive to antibiotics.^[1]^[3]

Overview

Definition and Background

Pouchitis is defined as idiopathic or secondary inflammation of the ileal pouch reservoir created via ileal pouch-anal anastomosis (IPAA) surgery.^[4]^[5] IPAA surgery involves restorative proctocolectomy, which removes the colon and rectum, followed by construction of an ileal pouch anastomosed to the anus; it is performed primarily for medically refractory ulcerative colitis (UC) or familial adenomatous polyposis (FAP).^[5]^[6] The most common configuration is the J-pouch, formed by folding approximately 30–40 cm of terminal ileum into a J-shape with two limbs of 15–20 cm each to create a reservoir for stool storage.^[7]^[8] The procedure was first described in 1978 by Parks and Nicholls, with pouchitis emerging as a recognized complication in the early 1980s as IPAA gained adoption.^[9]^[10] It has since become the most frequent long-term complication following IPAA.^[5]^[11] The ileal pouch is surgically fashioned from the small intestine to mimic colonic reservoir function, but its exposure to fecal stasis and altered microbial environment predisposes it to inflammation.^[12]^[13]

Epidemiology

Pouchitis is a frequent complication following ileal pouch-anal anastomosis (IPAA), particularly in patients with ulcerative colitis (UC), which serves as the primary indication for this surgery. The incidence of pouchitis in UC patients post-IPAA varies widely but typically ranges from 15% to 60% within 10 years, with some studies reporting cumulative rates up to 70% within the first 5 years.^[14]^[15] In contrast, the incidence is substantially lower in patients undergoing IPAA for familial adenomatous polyposis (FAP), ranging from 0% to 11%, reflecting differences in underlying disease mechanisms.^[16]^[17] Lifetime prevalence of pouchitis affects up to 50% of IPAA recipients overall, though rates are higher in those with UC compared to other indications such as FAP, where prevalence may be as low as 6%.^[3]^[18] Most cases manifest acutely within the first 1-2 years after surgery, with cumulative incidence reaching 48% by 2 years in UC cohorts.^[19] Demographic patterns indicate that pouchitis is more common in males, non-smokers, and patients with concomitant primary sclerosing cholangitis (PSC), the latter conferring a 79% cumulative risk at 10 years post-IPAA.^[14]^[15]^[20] Incidence rates have shown an increasing trend over recent decades, with a 38% relative rise from 1996 to 2018, driven by growing inflammatory bowel disease prevalence and IPAA procedures; however, global rates remain relatively stable as of 2025, though reported cases are rising with greater awareness.^[21]^[3]^[22]

Pathophysiology

Causes and Risk Factors

Pouchitis is a multifactorial inflammatory condition primarily affecting patients who have undergone ileal pouch-anal anastomosis (IPAA) surgery for ulcerative colitis (UC), with its etiology involving interactions between genetic predisposition, microbial dysbiosis, immune dysregulation, and various clinical risk factors.^[13]

Pathophysiological Mechanisms

The core mechanisms underlying pouchitis include microbial dysbiosis, characterized by reduced bacterial diversity and overgrowth of pathogenic species such as sulfate-reducing bacteria and Enterobacteriaceae, which impair mucosal barrier function and promote inflammation.^[23] This dysbiosis leads to decreased production of short-chain fatty acids (SCFAs) like butyrate, essential for epithelial integrity, and increased hydrogen sulfide, which exacerbates tissue damage.^[24] Abnormal mucosal immune responses further contribute, with heightened production of pro-inflammatory cytokines such as IL-1β, TNF-α, IL-6, and IL-8, alongside reduced anti-inflammatory IL-10, driving chronic inflammation in susceptible individuals.^[13] Genetic susceptibility plays a key role, with variants in genes like NOD2/CARD15 (e.g., rs2066847 polymorphism, odds ratio 3.21 for chronic pouchitis) and IL-10 pathway components increasing vulnerability to dysregulated innate immunity and pouch inflammation.^[23] Preoperative extensive colonic involvement in UC, including pancolitis and backwash ileitis, significantly elevates the risk of pouchitis development post-IPAA, likely due to persistent inflammatory priming of the ileal mucosa.^[25] Extraintestinal manifestations of UC, such as primary sclerosing cholangitis (PSC) and arthritis, are strongly associated with higher pouchitis incidence, reflecting shared immune-mediated pathways.^[13] Surgical factors, including hand-sewn anastomosis and proximity of the anastomosis to the dentate line (<0.5 cm), compromise pouch perfusion and increase early-onset risk.^[24]

Environmental and Lifestyle Factors

Non-smoking status is a notable risk factor, as active smoking appears protective against pouchitis, possibly through nicotine's immunomodulatory effects, with smokers showing a lower odds ratio (0.43) for chronic forms.^[25] Dietary influences, such as low intake of antioxidants or high-FODMAP foods, may indirectly contribute by altering the post-surgical microbiome and promoting oxidative stress.^[24] Younger age at surgery and perioperative use of corticosteroids have also been linked to increased susceptibility, potentially via microbiome disruption.^[13]

Secondary Causes

Non-idiopathic pouchitis can arise from ischemia due to impaired pouch blood supply, leading to refractory inflammation unresponsive to standard therapies.^[25] Infectious agents, including cytomegalovirus (CMV) and Clostridium difficile, trigger secondary episodes through direct mucosal invasion and toxin-mediated damage.^[23] Use of nonsteroidal anti-inflammatory drugs (NSAIDs) is a common precipitant, as they induce prostaglandin inhibition and epithelial injury in the pouch.^[24]

Classification

Pouchitis is classified temporally based on symptom duration, with acute pouchitis defined as inflammation lasting less than 4 weeks and typically self-limited, resolving with or without treatment, while chronic pouchitis involves symptoms persisting for more than 4 weeks or recurring frequently.^[26] This distinction helps differentiate initial episodes from ongoing disease processes.^[27] Recurrence patterns further subclassify the condition, categorizing it as infrequent acute pouchitis with 3 or fewer episodes per year, often resolving without recurrence after antibiotic therapy, relapsing acute pouchitis with more than 3 episodes per year requiring episodic treatment, and chronic antibiotic-dependent pouchitis (CADP) characterized by the need for continuous or frequent antibiotic use to maintain remission.^[27] These patterns reflect the disease's clinical course and guide long-term management strategies.^[26] Response to therapy provides another key classification axis, dividing pouchitis into antibiotic-responsive subtypes that resolve completely with a standard 2-week course of antibiotics such as metronidazole or ciprofloxacin, antibiotic-dependent forms that initially respond but relapse shortly after discontinuation, and antibiotic-refractory pouchitis (also termed chronic antibiotic-refractory pouchitis or CARP) where symptoms persist despite 4 weeks of conventional antibiotic therapy, necessitating alternative interventions.^[11] This response-based categorization is essential for tailoring therapeutic approaches.^[28] Etiologically, pouchitis is distinguished as idiopathic (primary), the most common form involving diffuse pouch inflammation without an identifiable cause and often linked to factors like dysbiosis, or secondary, accounting for up to 30% of cases and attributable to specific triggers such as infections (e.g., Clostridium difficile), nonsteroidal anti-inflammatory drug use, ischemia, or structural issues like strictures.^[28] Secondary pouchitis requires addressing the underlying etiology for resolution.^[11] As outlined in the 2024 American Gastroenterological Association guideline, Crohn's-like disease of the pouch is recognized as a distinct entity separate from idiopathic pouchitis, defined by complications such as fistulas, strictures, or pre-pouch ileitis occurring at least 12 months post-ileal pouch-anal anastomosis, often exhibiting unique immune profiles identified through advanced techniques like single-cell RNA sequencing.^[29]^[30]

Clinical Presentation

Signs and Symptoms

Pouchitis, a common complication following ileal pouch-anal anastomosis (IPAA) surgery, manifests primarily through gastrointestinal symptoms that reflect inflammation of the ileal pouch.^[2] Patients typically experience increased stool frequency, often exceeding 8-10 bowel movements per day, along with loose or watery stools.^[31] Additional gastrointestinal features include urgency to defecate, tenesmus (a sensation of incomplete evacuation), abdominal cramping or pain, nocturnal fecal seepage, and occasional fecal incontinence or rectal bleeding with bloody or mucoid stools.^[1] These symptoms can vary in intensity but often lead to significant discomfort and disruption.^[14] Systemic symptoms may accompany the gastrointestinal manifestations, including low-grade fever, malaise, and fatigue, which contribute to overall patient distress.^[31] In individuals with a history of underlying inflammatory bowel disease (IBD), extragastrointestinal symptoms such as arthralgia (joint pain), skin rashes, or eye inflammation can occur as extraintestinal manifestations.^[31] The collective impact of these symptoms on quality of life is substantial, often disrupting daily activities, sleep patterns, and social functioning, with severity correlating to the degree of pouch inflammation.^[11] Patients report decreased patient-reported outcomes, including heightened pain, depression, and fatigue, particularly in chronic cases.^[32]

Differential Diagnosis

Pouchitis, characterized by inflammation of the ileal pouch-anal anastomosis (IPAA), must be differentiated from other conditions that can cause similar symptoms such as increased stool frequency, urgency, and abdominal pain in post-IPAA patients to avoid misdiagnosis and inappropriate therapy.^[1] Accurate differentiation relies on a combination of clinical history, endoscopy, histology, and targeted testing, as overlapping features can complicate management.^[31] Infectious causes represent a key secondary etiology mimicking pouchitis, often presenting with acute inflammation responsive to specific antimicrobials rather than broad-spectrum antibiotics. Clostridium difficile infection is prevalent in up to 11% of refractory cases, diagnosed via stool toxin assays or PCR, and typically resolves with vancomycin therapy.^[1] Cytomegalovirus (CMV) infection, less common, is identified histologically by viral inclusion bodies in pouch biopsies and is more frequent in immunocompromised patients.^[31] Other pathogens, such as Candida species or bacterial overgrowth (e.g., Escherichia coli), can cause similar inflammatory changes, distinguished by microbial cultures or fungal stains.^[33] Inflammatory mimics include conditions that simulate idiopathic pouchitis but involve distinct pathologic processes. Crohn's disease of the pouch (CDP), also termed Crohn's-like ileitis, affects 2.7-13% of IPAA patients and is characterized by perianal fistulas, strictures, or prepouch ileitis developing >6-12 months post-surgery, often confirmed by endoscopy showing deep ulcers or granulomas on biopsy.^[33] Cuffitis, inflammation of the residual rectal cuff, presents with tenesmus and bloody stools due to anastomotic site involvement, diagnosed via targeted cuff biopsies revealing chronic inflammation without pouch body extension.^[1] Irritable pouch syndrome manifests functional symptoms like bloating and diarrhea without endoscopic or histologic inflammation, akin to irritable bowel syndrome, and is a diagnosis of exclusion.^[31] Mechanical or obstructive issues can produce pouch dysfunction resembling inflammatory pouchitis. Pouch outlet obstruction or strictures, occurring in about 11% of cases, lead to incomplete emptying and dilation, identified endoscopically or via contrast studies showing narrowing at the anastomosis.^[33] Afferent limb syndrome involves obstruction or inflammation in the inflow limb proximal to the pouch, causing bacterial stasis and symptoms of distension, differentiated by imaging demonstrating limb dilation.^[11] Other rare mimics encompass ischemic pouchitis, which features asymmetric inflammation often unresponsive to antibiotics and linked to vascular compromise, visible on endoscopy with patchy involvement sparing the afferent limb.^[31] Nonsteroidal anti-inflammatory drug (NSAID)-induced inflammation accounts for up to 30% of secondary cases and improves upon drug cessation, confirmed by history and resolution post-withdrawal.^[31] Malignancy, such as pouch adenocarcinoma, is exceedingly rare but must be excluded in chronic refractory cases through biopsy, particularly in patients with long-standing IPAA.^[33] In antibiotic-refractory scenarios, distinguishing from CDP is critical, with pelvic MRI recommended to detect fistulas or strictures not evident on routine endoscopy, as emphasized in recent evaluations.^[11]

Diagnosis

Diagnostic Approach

The diagnostic approach to pouchitis begins with a thorough initial assessment, including a detailed medical history and physical examination. The history focuses on the timing of symptoms relative to ileal pouch-anal anastomosis (IPAA) surgery, typically occurring within the first few years postoperatively, and the duration of symptoms, which helps differentiate acute episodes (lasting less than four weeks) from chronic ones (persisting beyond four weeks).^[1]^[34] Physical examination evaluates for signs of abdominal tenderness, fever, or dehydration, such as dry mucous membranes or reduced skin turgor, which may indicate systemic involvement or complications.^[35]^[1] Laboratory tests are essential to support the clinical suspicion and exclude infectious mimics. Stool studies, including testing for Clostridioides difficile toxin and cultures for bacterial pathogens like Salmonella or Shigella, are routinely performed to rule out secondary infections, particularly in patients with recent antibiotic exposure or hospitalization.^[1] Fecal calprotectin serves as a non-invasive marker of pouch inflammation, with levels above 100 µg/g suggesting active disease and aiding in risk stratification.^[36]^[37] Blood work, including C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), assesses for systemic inflammation, though these have limited sensitivity and specificity in isolation.^[38]^[1] Flexible pouchoscopy remains the gold standard for confirming pouchitis, allowing direct visualization of the pouch mucosa for signs of inflammation such as erythema, friability, granularity, loss of vascular pattern, and ulceration.^[1]^[36] Biopsies obtained during pouchoscopy provide histological confirmation, revealing characteristic features like neutrophilic infiltration, crypt abscesses, and mucosal ulceration, while helping exclude alternative pathologies such as cytomegalovirus (CMV) inclusions or ischemic changes.^[1]^[35] Additional imaging, such as magnetic resonance imaging (MRI) or computed tomography (CT) enterography, may be used if pouchoscopy suggests proximal small bowel involvement, and wireless capsule endoscopy can evaluate the pre-pouch ileum for Crohn's-like complications.^[1] Viral PCR testing on stool or tissue is recommended to exclude CMV or other viral infections in refractory cases.^[36] Exclusion of secondary causes is integrated throughout the evaluation to ensure accurate diagnosis. Recent 2025 perspectives emphasize performing early endoscopy in symptomatic patients post-IPAA to avoid diagnostic delays and promptly identify treatable etiologies like infections or mechanical issues.^[36]^[29]

Scoring Systems

The Pouchitis Disease Activity Index (PDAI) is the most widely used validated tool for evaluating pouchitis severity and therapeutic response, consisting of a composite score derived from clinical symptoms (0-6 points, assessing stool frequency, rectal bleeding, fecal urgency or abdominal cramps, and fever), endoscopic findings (0-6 points, evaluating granularity, edema, friability, loss of vascular pattern, mucus, and ulceration), and acute histologic features (0-6 points, focusing on neutrophil infiltration and ulceration breadth). The total PDAI score ranges from 0 to 18, with a threshold of ≥7 points indicating active pouchitis.^[39]^[10] Other indices include the Pouchitis Activity Score (PAS), also known as the Heidelberg PAS, a composite index that quantifies clinical manifestations such as daily stool frequency, nocturnal leakage, urgency, abdominal pain, malaise, fever, and arthralgia, along with endoscopic and histologic features (including chronic inflammation); scores >13 suggest pouchitis. The modified PDAI (mPDAI), an adaptation omitting the histologic component (total 0-12 points), incorporates symptoms and endoscopy in a manner akin to the modified Mayo score for ulcerative colitis, providing a practical alternative for trial endpoints and clinical assessment. These indices, particularly PDAI and mPDAI, are frequently employed in clinical trials to standardize eligibility and outcomes.^[40]^[41] Limitations of the PDAI include subjectivity in endoscopic grading, which can lead to interobserver variability. In 2025, the Atlantic Pouchitis Index (API) was developed and externally validated as an objective alternative, combining the Simple Endoscopic Score for Crohn's Disease (endoscopy, 0-56 points) and Robarts Histopathology Index (histology, 0-13 points) for a total range of 0-69, offering improved reliability for assessing pouch inflammation.^[40] In clinical practice, these scoring systems guide treatment escalation for persistent activity (e.g., PDAI ≥7 despite initial therapy) and define remission as an mPDAI score <5 accompanied by symptom resolution, facilitating standardized monitoring and trial design.^[42]

Treatment

Acute Pouchitis Management

The management of acute pouchitis, defined as an inflammatory episode of the ileal pouch lasting less than 4 weeks without complications, primarily involves antibiotic therapy as the first-line approach. Antibiotics such as ciprofloxacin (500 mg twice daily) or metronidazole (500 mg three times daily) are recommended for a duration of 2 to 4 weeks, with response rates typically ranging from 70% to 90% in uncomplicated cases.^[3]^[43] For severe episodes, combination therapy with both antibiotics may be employed to improve efficacy, as suggested by the 2024 American Gastroenterological Association (AGA) guidelines.^[3] Supportive care plays a key role in symptom control alongside antibiotics. Adequate hydration is essential to prevent dehydration from increased stool output, while antidiarrheal agents like loperamide (up to 8 mg daily) can reduce stool frequency and improve continence.^[44] Dietary modifications, such as a low-residue diet limiting high-fiber foods to 10-15 grams per day during flares, help minimize bowel irritation and stool volume by reducing fermentable substrates.^[45]^[46] Patients should be monitored for symptom resolution, which generally occurs within 1 to 2 weeks of initiating therapy. If symptoms persist, endoscopic evaluation is indicated to confirm ongoing inflammation and exclude alternative diagnoses.^[3] Routine antibiotic prophylaxis before or after ileal pouch-anal anastomosis (IPAA) surgery is not recommended, per the AGA's stance against its use for primary prevention due to insufficient evidence and potential risks.^[47]

Chronic and Refractory Pouchitis

Chronic pouchitis is defined as persistent inflammation lasting more than 4 weeks or recurrent episodes requiring repeated treatment, while refractory pouchitis refers to cases unresponsive to standard antibiotic therapy.^[48]

Chronic Antibiotic-Dependent Pouchitis (CADP)

Patients with chronic antibiotic-dependent pouchitis (CADP) experience recurrent symptoms that respond to antibiotics but necessitate ongoing or cyclical therapy to prevent flares. Management typically involves cyclical antibiotics, such as ciprofloxacin 500 mg twice daily for 2 weeks each month, to maintain remission while minimizing long-term exposure.^[3] Alternatively, daily probiotics like VSL#3 (one sachet containing 900 billion colony-forming units) are recommended for maintenance, with studies demonstrating efficacy in preventing recurrence in 60-80% of cases over 6-12 months compared to placebo.^[49]

Antibiotic-Refractory Pouchitis (CARP)

In antibiotic-refractory pouchitis (CARP), where symptoms persist despite adequate antibiotic courses, escalation to advanced immunosuppressive therapies is required. According to 2024 American Gastroenterological Association (AGA) guidelines and the 2023 EARNEST randomized controlled trial, biologics are suggested as first-line therapy; vedolizumab (300 mg intravenously every 8 weeks after induction doses at weeks 0, 2, and 6) induces remission in 31% of patients at week 14 versus 10% with placebo.^[3]^[50] For vedolizumab failures, anti-TNF agents like infliximab (5 mg/kg intravenously at weeks 0, 2, and 6, then every 8 weeks) or ustekinumab (initial 260 mg intravenously based on weight, followed by 90 mg subcutaneously every 8 weeks) yield clinical remission rates of about 51% for infliximab and clinical response rates of about 59% for ustekinumab, respectively, in observational cohorts.^[51]

Surgical Options

Surgical intervention for chronic or refractory pouchitis is reserved for cases of pouch failure, occurring in 5-10% of patients overall, and involves pouch diversion with ileostomy or complete excision.^[52] These procedures are considered only after exhaustive medical optimization, as they carry risks of permanent stoma and reduced quality of life.^[3]

Emerging Therapies

Budesonide (9 mg orally once daily) is suggested by 2024 AGA guidelines for refractory pouchitis, with targeted anti-inflammatory effects and reduced systemic absorption.^[3] Fecal microbiota transplantation (FMT) trials, including multi-donor protocols via colonoscopy or enema, demonstrate clinical response rates of approximately 33-43% in antibiotic-dependent or refractory cases at 8-12 weeks, with ongoing randomized studies evaluating durability and safety.^[53]^[54]

Prognosis and Prevention

Outcomes and Complications

The prognosis for patients with pouchitis following ileal pouch-anal anastomosis (IPAA) for ulcerative colitis is generally favorable with initial treatment, as approximately 70-80% achieve clinical remission after a single course of antibiotics.^[55]^[38] However, chronic forms of pouchitis, particularly chronic antibiotic-refractory pouchitis (CARP), are associated with recurrence rates of 15-40%, contributing to persistent symptoms and diminished health-related quality of life.^[38] Patients with recurrent or chronic pouchitis often report lower scores on the SF-36 questionnaire across multiple domains, reflecting reduced physical and mental well-being compared to those without pouchitis or the general population.^[56]^[57] Complications of pouchitis can significantly impact long-term pouch function, with pouch failure occurring in 5-10% of cases overall, often necessitating surgical revision or excision.^[52] Common associated issues include strictures, fistulas, and malnutrition due to chronic inflammation and malabsorption, which are more prevalent in refractory cases.^[58] In patients with CARP, the rate of pouch failure rises to approximately 16%, highlighting the heightened risk in this subgroup.^[59]^[60] Direct mortality from pouchitis remains low, with no significant increase attributable to the condition itself; however, chronic pouchitis leads to substantial morbidity, including frequent hospitalizations and elevated healthcare utilization.^[5] Recent data indicate that biologic therapies, such as vedolizumab and anti-TNF agents, achieve clinical remission in approximately 30-60% of refractory cases, depending on the agent and study, thereby potentially reducing the risk of pouch failure.^[61]^[62] Several factors influence outcomes in pouchitis, including the timing of intervention and comorbidities. Early diagnosis and prompt antibiotic therapy enhance remission rates and prevent progression to chronic disease.^[63] In contrast, the presence of primary sclerosing cholangitis (PSC) as a comorbidity worsens prognosis, with PSC-associated pouchitis showing higher rates of chronicity and reduced responsiveness to standard treatments.^[64]^[65]

Preventive Strategies

Probiotic prophylaxis plays a key role in preventing pouchitis recurrence, particularly in patients with a history of the condition. The De Simone formulation (formerly known as VSL#3), administered as one daily sachet containing high concentrations of beneficial bacteria (approximately 6 × 10¹² colony-forming units), has been shown to maintain antibiotic-induced remission in 85% of patients with recurrent or refractory pouchitis over one year. The American Gastroenterological Association (AGA) suggests using multistrain probiotics such as the De Simone formulation for secondary prevention in patients experiencing recurrent episodes that respond to antibiotics (conditional recommendation, low certainty of evidence).^[3] This approach is typically initiated immediately after completing antibiotic therapy to support pouch microbiome stability and reduce relapse risk. Emerging therapies like fecal microbiota transplantation (FMT) show potential in maintaining remission, though larger trials are needed as of 2025.^[65] Lifestyle modifications can further mitigate pouchitis incidence by addressing modifiable risk factors. Avoidance of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, is advised, as postoperative NSAID use is associated with an increased risk of chronic pouchitis due to their potential to induce mucosal inflammation.00604-4/fulltext) Smoking exhibits a paradoxical protective effect against pouchitis development in ulcerative colitis patients post-IPAA, possibly through modulation of immune responses, though cessation counseling remains essential given the broader health risks of tobacco use.^[66] Optimized nutrition, including a diet rich in probiotics from sources like yogurt and fermented vegetables, supports gut microbiota diversity and may help prevent dysbiosis-linked inflammation.^[67] Surgical optimizations during ileal pouch-anal anastomosis (IPAA) are crucial for high-risk ulcerative colitis patients to minimize early postoperative inflammation and pouchitis risk. A staged approach, such as a three-stage procedure involving initial subtotal colectomy with ileostomy followed by delayed pouch construction, is preferred in patients with severe colonic inflammation or those on high-dose steroids, as it allows for better healing and reduced complication rates compared to single-stage surgery.^[68] Routine monitoring protocols enable early detection and intervention to prevent pouchitis progression. Guidelines recommend pouchoscopy with biopsies at one year post-IPAA to assess for subclinical inflammation, with follow-up endoscopies every 1-2 years thereafter in at-risk patients.^[69] Emerging research highlights the potential of microbiome screening, such as fecal analysis for dysbiosis markers, to identify high-risk individuals early, though this is not yet standard in clinical guidelines as of 2025.^[70]

Ongoing Research

Current Developments

Recent studies from 2024 and 2025 have further elucidated the role of gut microbiome dysbiosis in pouchitis pathogenesis, consistently identifying signatures such as reduced abundance of Firmicutes and Bacteroidetes phyla alongside increased Proteobacteria.^[71]^[72] These findings, derived from metagenomic analyses of pouch biopsies and fecal samples in patients with chronic pouchitis, underscore a shift toward pro-inflammatory microbial communities that correlate with disease severity.^[73] Fecal microbiota transplantation (FMT) has emerged as a promising intervention for chronic antibiotic-refractory pouchitis (CARP), with clinical trials reporting remission rates of approximately 30% and response rates up to 43% following multi-donor or single-donor protocols.^[54] A 2024 meta-analysis of FMT in chronic pouchitis cohorts indicated endoscopic remission in about 10-15% of CARP cases, though higher clinical response rates (around 40%) were observed with optimized donor selection and repeated administrations.^[74] These outcomes highlight FMT's potential to restore microbial diversity, albeit with variability influenced by engraftment success.^[75] Advancements in biomarker research have identified elevated fecal calprotectin levels and increased Smad7 expression in pouch mucosa as reliable predictors of pouchitis activity and progression.^[76] Fecal calprotectin, in particular, demonstrates high sensitivity for detecting mucosal inflammation, aiding in non-invasive monitoring of therapeutic response.^[77] A 2025 study published in Frontiers in Immunology confirmed that high Smad7 expression marks chronic inflammation in pouchitis patients, reinforcing its role as a therapeutic target, though direct inhibition trials for refractory cases remain in early exploration.^[78] The American Gastroenterological Association (AGA) published its clinical practice guidelines on pouchitis management in 2024, refining recommendations to prioritize vedolizumab as first-line biologic therapy for chronic and refractory cases due to its favorable efficacy and safety profile in post-surgical ulcerative colitis patients.^[3] Real-world data from population-based studies corroborate this, showing endoscopic response rates of approximately 60% with vedolizumab in chronic pouchitis, outperforming anti-TNF agents in sustained remission.^[79] These updates emphasize patient-centered approaches, integrating biologics earlier in antibiotic-refractory scenarios.^[80] Diagnostic innovations include AI-assisted endoscopy systems that enhance the accuracy of Pouchitis Disease Activity Index (PDAI) scoring by automating image recognition of mucosal inflammation during pouchoscopy.^[81] A 2024 prospective study demonstrated that AI tools improved inter-observer agreement and detection sensitivity for pouchitis features, potentially reducing diagnostic variability in clinical practice.^[82] Such technologies are poised to standardize assessments, particularly in resource-limited settings.^[83]

Future Directions

Promising therapeutic frontiers in pouchitis management include small-molecule inhibitors such as Janus kinase (JAK) inhibitors. Tofacitinib, a JAK inhibitor, has demonstrated clinical remission in 31% of patients with chronic pouchitis after 8 weeks in a pilot study, highlighting its potential for chronic antibiotic-refractory pouchitis (CARP), with ongoing trials evaluating its efficacy in refractory cases.^[84]^[85] Stem cell therapies, particularly allogeneic bone marrow-derived mesenchymal stem cells, are under investigation for pouch regeneration, with phase I trials assessing safety and feasibility in treating pouch inflammation.^[86] Anti-Smad7 agents represent another avenue, as elevated Smad7 levels in the inflamed mucosa of chronic pouchitis patients support its pathogenic role, and a 2025 study confirmed high Smad7 expression, building on antisense oligonucleotide approaches in broader inflammatory bowel disease contexts.^[87]^[88] Key research gaps persist, including the need for longitudinal studies on pouch microbiota dynamics to better understand dysbiosis progression in chronic pouchitis.^[89] Personalized medicine approaches, such as genetic profiling for IL-10 pathway variants, hold promise for tailoring therapies, though trials remain limited to inflammatory bowel disease models. Prevention strategies for high-risk groups, like patients with primary sclerosing cholangitis (PSC), require further exploration, as altered bile acid and microbiota compositions in PSC-associated chronic pouchitis suggest targeted interventions could mitigate onset.^[90]^[91] The clinical trial landscape features ongoing randomized controlled trials (RCTs) aimed at standardizing fecal microbiota transplantation (FMT) protocols to restore pouch microbial balance, such as extensions of NCT03524352 for prophylaxis of recurrent pouchitis. Novel biologics, including IL-23 inhibitors, are being evaluated for refractory pouchitis, extending from their use in ulcerative colitis. As of 2025, phase I trials such as NCT05578508 are evaluating allogeneic mesenchymal stem cells for pouchitis safety and feasibility. Market forecasts project significant growth in biologics for pouchitis, with the overall treatment market expected to reach USD 2.83 billion by 2034 at a compound annual growth rate of 6.8%, driven by expanded therapeutic options.^[92]^[93]^[94]^[95] Challenges in advancing pouchitis research include developing pouch-specific endpoints to improve trial outcomes and incorporating diverse patient cohorts to address understudied demographics, such as ethnic minorities and elderly populations often excluded from studies. These efforts are crucial for overcoming barriers in drug development and ensuring equitable progress.^[96]^[97]

References

[1]
Pouchitis: Clinical Features, Diagnosis, and Treatment - PMC
24 thg 7, 2021 · Pouchitis is a non-specific inflammation of the ileal reservoir, and the most common, inflammatory and long-term, complication after pouch surgery for ...
[2]
Pouchitis - Symptoms and causes - Mayo Clinic
25 thg 10, 2024 · Pouchitis is swelling and irritation, called inflammation, in the lining of a pouch made during surgery to remove the colon.
[3]
Ouch, my pouch! a clinician's guide to pouchitis - ScienceDirect
Pouchitis is defined as inflammation of the ileal pouch created during a restorative proctocolectomy with ileal pouch-anal anastomosis.
[4]
AGA Clinical Practice Guideline on the Management of Pouchitis ...
Pouchitis is the most common complication after restorative proctocolectomy with ileal pouch–anal anastomosis for ulcerative colitis. This American ...
[5]
Ileal Pouch-Anal Anastomosis - Medscape Reference
Jul 28, 2023 · The ileal pouch–anal anastomosis (IPAA) is a surgical procedure that is used to restore gastrointestinal continuity after surgical removal of the colon and ...
[6]
J-Pouch: What It Is, Surgery & Complications - Cleveland Clinic
The J-pouch is one solution that your surgeon can create. It's an internal pouch made from the end of your small intestine that connects to your anal canal.
[7]
Ileal Pouch–Anal Anastomosis Surgery: Imaging and Intervention for ...
Figure 1 Illustration shows the surgical technique for creation of an IPAA with a J configuration. The distal end of the ileum is closed with staples (black ...
[8]
Restorative pouch surgery following proctocolectomy for ...
John Nicholls are credited as the first to describe the IPAA after fashioning an S-pouch for patients with UC after proctocolectomy in 1978 (9). While the S ...
[9]
Pouchitis: a practical guide - PMC - NIH
Before the 1980s surgical management typically involved a total proctocolectomy and permanent ileostomy. However, advances in surgical techniques led to the ...Introduction · Diagnosing Pouchitis · Treatment Of Pouchitis
[10]
Pouchitis unveiled: exploring clinical features, diagnosis, and cutting ...
Jan 27, 2025 · Pouchitis, an inflammatory condition of the ileal pouch, is the most common long-term complication of IPAA, affecting almost one-half of ...
[11]
Pouchitis: insight into the pathogenesis and clinical aspects - PMC
Mark's Hospital in London agreed to carry out a three-limbed ileal reservoir with ileoanal anastomosis, creating the first IPAA. They fashioned an S-shaped ...
[12]
Pouchitis in inflammatory bowel disease: a review of diagnosis ... - NIH
The cumulative risk of pouchitis at 10 years after IPAA was 79% for UC patients with PSC and 46% for those without [41]. Backwash ileitis, which is frequently ...Pouchitis In Inflammatory... · 1. Acute Pouchitis · 2. Chronic Pouchitis
[13]
Risk factors associated with the development of chronic pouchitis ...
Mar 18, 2025 · The most commonly reported complication following IPAA surgery is pouchitis, which can develop in up to 70% of patients within 5 years of ...
[14]
Incidence, Prevalence, and Risk Factors for Pouchitis | Request PDF
Aug 10, 2025 · The reported cumulative frequency rates of pouchitis 10 years after IPAA surgery range from 23–60% in IBD patients and 0–11% in FAP patients.
[15]
Prevalence of pouchitis in both ulcerative colitis and familial ...
Nov 20, 2021 · The prevalence of pouchitis in UC was 0.32 (95% CI 0.27–0.37) and in FAP was found to be 0.06 (95% CI 0.03–0.15). The odds ratio of pouchitis in ...
[16]
https://www.sciencedirect.com/science/article/abs/pii/S1043148917300404
[17]
Pouchitis - PMC - NIH
Reported cumulative frequency rates of pouchitis 10-11 years after IPAA surgery range from 23% to 46%[3,4]. It is estimated that approximately 50% of patients ...Missing: lifetime | Show results with:lifetime<|separator|>
[18]
Rate, Risk Factors, and Outcomes of Pouchitis After Liver...
Introduction: The presence of primary sclerosing cholangitis (PSC) is associated with an increased risk of chronic pouchitis following total proctocolectomy ...
[19]
Pouchitis Market Size, Share, Industry, Forecast and Outlook (2024 ...
Sep 12, 2025 · Discover the growing pouchitis market from 2024-2031, driven by IBD prevalence, IPAA surgeries, and antibiotic treatments.<|control11|><|separator|>
[20]
Review article: the pathogenesis of pouchitis - PMC - NIH
The pathogenesis of pouchitis is not well defined although multiple etiologies have been suggested, including: bacterial dysbiosis, SCFA deprivation, immune ...
[21]
The aetiology of pouchitis in patients with inflammatory bowel disease
May 27, 2024 · Specifically, whilst pouchitis occurs in about 58% of patients with UC, it is only seen in about 5% of patients with FAP. Given both UC and FAP ...
[22]
https://www.datamintelligence.com/research-report/pouchitis-market
[23]
Medical treatment of pouchitis: a guide for the clinician - PMC - NIH
Common risk factors include genetic mutations, extensive colitis, rheumatologic disorders, and primary sclerosing cholangitis. Currently, there are no ...
[24]
Inflammatory pouch disease: The spectrum of pouchitis
Interestingly, while pouchitis may occur in up to 50% of patients with UC, it is rarely seen in patients with FAP[2,3]. This suggests that the pathogenetic ...
[25]
Diagnosis and Medical Treatment of Acute and Chronic Idiopathic ...
Pouchitis is the most common complication in these patients, where up to 60% develop one episode of pouchitis in the first two years after UC surgery with IPAA ...
[26]
Inflammatory pouch disease: The spectrum of pouchitis - PMC - NIH
... pouchitis[11]. Risk factors. Reported risk factors for pouchitis include genetic susceptibility (polymorphisms of IL-1ra and NOD2/CARD15, non-carrier status ...Idiopathic Pouchitis · Secondary Pouchitis · Cmv Pouchitis
[27]
Chronic Antibiotic Dependent Pouchitis Is Associated With Older ...
Patients with pouchitis symptoms have demonstrated clinically significant decreases in patient-reported outcomes, such as pain, depression, and fatigue.
[28]
Diagnosis and Management of Postoperative Ileal Pouch Disorders
Endoscopy is the most reliable tool for diagnosis and differential diagnosis of pouchitis. Ideally, a combined assessment of symptoms and endoscopic and ...
[29]
A Review of the Diagnosis and Treatment of Inflammatory Pouch ...
May 11, 2023 · The aim of this study is to review the diagnosis and treatment of inflammatory pouch disorders, focusing on acute pouchitis, chronic antibiotic dependent ...
[30]
Pouchitis - Diagnosis and treatment - Mayo Clinic
Oct 25, 2024 · Diagnosis. To diagnose pouchitis, a healthcare professional will likely start by taking a medical history and doing a physical exam.Missing: approach initial
[31]
Navigating Chronic Pouchitis: Pathogenesis, Diagnosis, and ...
Abstract: Chronic pouchitis affects 13% to 17% of patients with ileal pouch–anal anastomosis and ulcerative colitis, and 20% with a history of acute ...
[32]
Associations between Pouchitis and Fecal Calprotectin after ... - NIH
Elevated fecal calprotectin appeared to be significantly correlated with pouchitis. We should consider the alteration of this marker during treatments in ...
[33]
Chronic pouchitis: what every gastroenterologist needs to know
Chronic pouchitis occurs in 10%–15% of pouches for ulcerative colitis. Rates of pouchitis seem to be increasing and chronic pouchitis is associated with ...Introduction · Acute Pouchitis · Chronic Pouchitis
[34]
AGA Clinical Practice Guideline on the Management of Pouchitis ...
In addition, approximately 17% patients may develop chronic symptoms of pouchitis, with relapsing-remitting course at varying intervals and 10% patients may ...
[35]
Pouchitis after ileal pouch-anal anastomosis - PubMed
The PDAI provides simple, objective, and quantitative criteria for pouch inflammation after IPAA and is more sensitive than prior scoring systems.Missing: details validation
[36]
Disease Activity Indices for Pouchitis: A Systematic Review - PMC
Jun 28, 2021 · The Pouchitis Disease Activity Index (PDAI) was most commonly used (12 of 18; 66.7%) to define both trial eligibility (8 of 12; 66.7%), and ...
[37]
Comparative Analysis of Clinical Symptoms and Modified Pouchitis ...
Aug 2, 2024 · The modified pouchitis disease activity index (mPDAI) based on clinical symptoms and endoscopic findings is used to diagnose pouchitis, but ...Materials And Methods · Results · Patient Characteristics
[38]
NCT02790138 | A Study to Evaluate the Efficacy and Safety of ...
Clinically relevant remission is defined as modified Pouchitis Disease Activity Index (mPDAI) score <5 and a reduction of mPDAI score by ≥2 points from Baseline ...
[39]
Pouchitis: Treatment dilemmas at different stages of the disease
Apr 1, 2020 · Antibiotics are the first-line treatment for acute pouchitis, with response rates near to 80%. Both metronidazole and ciprofloxacin are ...
[40]
A Personalized Approach to Managing Patients With an Ileal Pouch ...
Antidiarrheal medications such as loperamide, diphenoxylate/atropine, and codeine can be used to help reduce pouch frequency. Evidence supporting their efficacy ...Missing: hydration | Show results with:hydration
[41]
Low Residue Diet - StatPearls - NCBI Bookshelf
In summary, a low-residue diet is a restrictive diet that has both diagnostic and therapeutic roles. Regardless of the clinical indication, a low-residue diet ...
[42]
[PDF] Low Residue vs. Low Fiber Diets in Inflammatory Bowel Disease
The low residue diet has traditionally been used to reduce fecal volume in a number of situations: to treat diarrhea, keep wounds free from stool, promote ...
[43]
First comprehensive medical guideline on management of pouchitis ...
Dec 19, 2023 · AGA suggests cyclical or near continuous antibiotic therapy to treat pouchitis that responds to antibiotics but recurs frequently and shortly ...Missing: acute | Show results with:acute
[44]
Approach to Therapy for Chronic Pouchitis - Annual Reviews
Jan 27, 2025 · Combined ciprofloxacin and tinidazole therapy in the treatment of chronic refractory pouchitis. . Dis. Colon Rectum 50::498–508. [Google Scholar].
[45]
Once daily high dose probiotic therapy (VSL#3) for maintaining ...
The current study has confirmed the effectiveness of VSL#3 as a maintenance treatment in patients with recurrent or refractory pouchitis. Four aspects of the ...
[46]
Effectiveness and safety of azathioprine for inflammatory pouch ...
Mar 4, 2024 · The standard dose used was 2.5 mg/kg/day. At 12 months, 19 patients (30%) were in clinical remission and 33 (52%) had achieved a clinical ...
[47]
https://gastro.org/press-releases/first-comprehensive-guideline-on-management-pouchitis/
[48]
Comprehensive systematic review and pooled analysis of real ... - NIH
Dec 7, 2023 · Vedolizumab and ustekinumab appeared effective and safe for chronic pouchitis, whereas anti‐TNFs showed higher adverse events rates.
[49]
Prevalence of 'pouch failure' of the ileoanal pouch in ulcerative colitis
Nov 26, 2021 · This systematic review and meta-analysis of patients with UC who underwent IPAA demonstrates an overall prevalence of pouch failure of 6%.
[50]
[PDF] Navigating Chronic Pouchitis: Pathogenesis, Diagnosis, and ...
Jan 1, 2025 · Oral budesonide in the treatment of chronic refractory pouchitis. Aliment Pharmacol Ther. 2007;25(10):1231-1236. 83. Travis S, Silverberg MS ...
[51]
Safety and Efficacy of Fecal Microbiota Transplant in Chronic ...
We conducted a systematic review and meta-analysis evaluating the safety and efficacy of fecal microbiota transplant (FMT) in chronic antibiotic dependent and ...
[52]
When Should Chronic Pouchitis Be Treated as Crohn's Disease?
The prevalence of pouchitis increases with time, with cumulative incidence rates of 25% at 1 year, 35% at 3 years and 45% at 5 years (2). Antibiotics are the ...Missing: lifetime | Show results with:lifetime
[53]
SF-36 results for patients with pouchitis compared with patients...
The study aimed to evaluate long-term health-related quality of life (HRQOL) and functional outcome in patients who had undergone restorative ...
[54]
Long-Term Followup with Evaluation of the Surgical and Functional ...
Operation time, postoperative complications and pouchitis were determinators for reservoir failure and reduced quality of life. The functional results at ...
[55]
Review of long‐term complications and functional outcomes of ...
Apr 24, 2023 · Inflammatory pouch complications such as pouchitis, cuffitis and Crohn's disease of the pouch (CDP) are the most common chronic complications.Study Selection · Chronic Pouchitis · Risk Factors For...
[56]
Incidence, Risk Factors, and Outcomes of Chronic Antibiotic ...
May 15, 2025 · The study investigated the incidence, risk factors, and clinical outcomes of chronic antibiotic-refractory pouchitis (CARP) in Korean patients with ulcerative ...Missing: RCT | Show results with:RCT
[57]
Incidence, Risk Factors, and Outcomes of Chronic Antibiotic ... - NIH
The pouch failure rate for CARP was 16.1% and the endoscopic remission rate was 9.7% during a median follow-up of 4.6 years. Compared with the pooled pouch ...
[58]
Approach to Therapy for Chronic Pouchitis - Annual Reviews
Chronic antibiotic-dependent pouchitis (CADP) involves persistent (≥4 weeks) or recurrent (four or more episodes per year) symptoms of pou- chitis that are ...
[59]
Vedolizumab for the Treatment of Chronic Pouchitis
Mar 29, 2023 · Pouchitis Disease Activity Index (PDAI) scores range from 0 to 18, with a cutoff of 7 for the differentiation between “pouchitis” (≥7 points) ...<|control11|><|separator|>
[60]
Pouchitis Common After Ileal Pouch-Anal Anastomosis in Patients ...
Jul 15, 2024 · More than one-half of patients with ulcerative colitis (UC) develop intermittent pouchitis within 1 year after ileal pouch-anal anastomosis ...
[61]
Primary Sclerosing Cholangitis–Associated Pouchitis: A Distinct ...
Feb 3, 2021 · Patients with PSC who are diagnosed with pouchitis after IPAA are more likely to develop chronic pouchitis that is less responsive to ...Missing: prognosis | Show results with:prognosis
[62]
Primary Sclerosing Cholangitis-Associated Pouchitis - PubMed
Feb 4, 2021 · Pouchitis develops more frequently in patients with PSC, potentially leading to increased morbidity. We aimed to assess clinical ...Missing: comorbidity prognosis
[63]
Smoking may prevent pouchitis in patients with restorative ... - Gut
Smoking may prevent pouchitis in patients with restorative proctocolectomy for ulcerative colitis. Gastroenterology Unit, Radcliffe Infirmary, Oxford.Missing: protective | Show results with:protective
[64]
Pouchitis: What It Is, Symptoms, Causes & Treatment
Pouchitis is inflammation in your ileal pouch. It can happen to people who've had ileal pouch surgery. It causes symptoms like urgent diarrhea and cramping.Symptoms And Causes · What Causes Pouchitis? · Management And TreatmentMissing: classification refractory etiological idiopathic<|control11|><|separator|>
[65]
2-Stage and 3-stage restorative proctocolectomy with ileal pouch ...
Oct 1, 2024 · The three-stage approach is preferred in high-risk patients with severe inflammation of the colon or those undergoing high-dose steroid or ...Missing: prevention | Show results with:prevention
[66]
A Personalized Approach to Managing Patients With an Ileal Pouch ...
Until there is further evidence to support their efficacy, probiotic agents are not recommended for the treatment of acute antibiotic-responsive pouchitis.<|control11|><|separator|>
[67]
Altered Bile Acids and Pouch Microbiota Composition in Patients ...
Mar 12, 2025 · This article looks at how changes in bile acids and gut bacteria might contribute to chronic pouchitis, a condition that can develop after surgical removal of ...Lay Summary · Altmetric · New Journal Issues Alert
[68]
Pouchitis unveiled: exploring clinical features, diagnosis, and cutting ...
Jan 27, 2025 · Several risk factors for pouchitis have been identified, including an extensive UC before IPAA, backwash ileitis, extraintestinal ...
[69]
Gut Microbiome Dysbiosis and Inflammatory Bowel Disease ...
Feb 25, 2025 · Gut microbiota dysbiosis in patients with IBD is characterized by decreased Bacteroidetes and Firmicutes, increased Proteobacteria and ...
[70]
Understanding dysbiosis and resilience in the human gut microbiome
The most prominent features reported in these studies are the increased Bacillota to Bacteriodota (Firmicutes to Bacteroidetes) ratio as well as a shift in the ...
[71]
Faecal Microbiota Transplantation [FMT] in the Treatment of Chronic ...
Jan 27, 2024 · Clinical response rate of 42.6% with a remission rate of 29.8% was estimated in our cohort following FMT therapy. Minor, self-limiting ...Missing: CARP 2025
[72]
Fecal Microbiota Transplantation for Chronic Pouchitis - NIH
Nov 26, 2024 · FMT with a single donor source had a higher overall remission rate (24%, 95% CI: 2–46%, p = 0.01) compared to multiple donor sources (0%, 95 ...Missing: CARP 2025
[73]
Faecal Microbiota Transplantation [FMT] in the Treatment of Chronic ...
Jul 14, 2023 · The search was performed by two independent reviewers using the following search terms 'faecal microbiota transplantation, fecal microbiota ...
[74]
Biomarkers for the Evaluation of Pouch Inflammation: A Systematic ...
Prediction of stool biomarkers. ... Faecal matrix metalloprotease-9 is a more sensitive marker for diagnosing pouchitis than faecal calprotectin: results from a ...Missing: Smad7 2024 2025
[75]
Fecal, Blood, and Urinary Biomarkers in Inflammatory Bowel Diseases
Jun 28, 2024 · Fecal Calprotectin Is a Predictor of Need for Rescue Therapy in Hospitalized Severe Colitis. Inflamm Bowel Dis 2022;28(12):1833-1837 View ...Missing: Smad7 | Show results with:Smad7
[76]
High Smad7 marks inflammation in patients with chronic pouchitis
Mar 2, 2025 · Received: 20 December 2024; Accepted: 17 February 2025; Published ... non-Amish (Urban) Infant Fecal Microbiotas Are Highly Diverse and ...Missing: calprotectin predictors
[77]
Comparative Effectiveness of Ustekinumab and Vedolizumab in the ...
Oct 14, 2025 · Endoscopic response was reported in 60% and 67% of patients with chronic pouchitis and CD of the pouch after 24–32 and 8–24 weeks of treatment ...<|separator|>
[78]
https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2025.1549193/full
[79]
P609 Artificial intelligence in the image recognition of ...
Pouchoscopy is the diagnostic tool of choice to examine the pouch in cases of pouchitis. Artificial intelligence (AI)-based image recognition programmes can ...
[80]
Artificial Intelligence in Image Recognition of Pouchoscopies in ...
Pouchoscopy can be used to monitor the success of therapy and to detect complications such as pouchitis or neoplasia. Artificial Intelligence assisted image ...
[81]
P609 Artificial intelligence in the image recognition of ...
Apr 8, 2025 · Pouchoscopy is the diagnostic tool of choice to examine the pouch in cases of pouchitis. Artificial intelligence (AI)-based image recognition ...
[82]
Tofacitinib for the treatment of chronic pouchitis: A pilot study - NIH
At baseline, the median daily stool frequency was 9 (IQR 7–10) and during ... 10 (6–10), 9 (8–11), 1.000. Night, 2 (1–5), 2 (1–5), 3 (2–5), 0.628. CRP, median ...Table 1 · Clinical, Endoscopic And... · Discussion<|separator|>
[83]
Treatment of refractory pouchitis with tofacitinib - MedPath
Subject has a history of ileal pouch anal anastomosis (IPAA) for UC, all stages completed at least 6 months prior to day one of the start of the study.
[84]
Stem Cells for the Treatment of Pouchitis | Clinical Research Trial ...
Oct 9, 2022 · The purpose of this study is to determine the safety and feasibility of using allogeneic bone marrow derived mesenchymal stem cells (MSCs) ...Missing: Smad7 | Show results with:Smad7
[85]
High Smad7 marks inflammation in patients with chronic pouchitis
Mar 3, 2025 · High Smad7 occurs in the inflamed mucosa of patients with CP, further supporting the pathogenic role of Smad7 in the gut.Missing: refractory | Show results with:refractory
[86]
Raising the bar in ulcerative colitis management - Sage Journals
Nov 24, 2024 · C-reactive protein (CRP) and fecal calprotectin (FC) correlate with clinical, endoscopic, and histological activity both in adults and children.<|separator|>
[87]
Altered Bile Acid and Pouch Microbiota Composition in Patients With ...
Jul 3, 2024 · Aims: The goal of the study was to compare pouch microbiota and stool bile acid composition in patients with chronic pouchitis, chronic ...
[88]
Gut microbiota in liver diseases: initiation, development and therapy
This review summarizes the latest research advances on the role of gut microbiota in liver diseases, offering novel theoretical foundations and practical ...<|separator|>
[89]
British Society of Gastroenterology guidelines on inflammatory ... - Gut
Chronic pouchitis may be treated with a combination of antibiotics (ciprofloxacin, metronidazole, tinidazole, rifaximin), oral budesonide or oral beclometasone.
[90]
https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2025.1615839/full
[91]
Challenges and opportunities for IBD drug development - Gut
Jun 6, 2020 · There are several challenges in IBD drug development, including a slow drug development process and the exclusion of certain study populations ...Missing: forecast | Show results with:forecast
[92]
Challenges in IBD Research 2024: Pragmatic Clinical Research
This summary provides a comprehensive overview of current gaps in inflammatory bowel disease (IBD) clinical research and actionable approaches to address them.<|control11|><|separator|>