Materiały źródłowe

• #1 Review article: the pathogenesis of pouchitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5785099/

  A total proctocolectomy followed by ileal pouch-anal anastomosis (IPAA) is a potentially curative surgery for ulcerative colitis (UC) or familial adenomatous polyposis (FAP). About 5-35% of UC patients and 0-11% of FAP patients develop subsequent inflammation of the ileal pouch termed pouchitis. […] The pathogenesis of pouchitis is not definitively understood, but various hypotheses have been proposed, including: 1) recurrence of UC, 2) dysbiosis of the ileal pouch microbiota, 3) deprivation of nutritional short chain fatty acids, 4) mucosal ischemia and oxygen free radical injury, 5) host genetic susceptibility, and 6) immune dysregulation. However, none of these alone are able to fully explain pouchitis pathogenesis. […] Pouchitis, similar to IBD, is a complex disorder that is not caused by any one single factor. More likely, pouchitis occurs through a combination of both dysregulated host inflammatory mechanisms and interaction with luminal microbiota.

• #2 Pouchitis | IBDrelief

  https://www.ibdrelief.com/learn/complications-of-ibd/pouchitis

  Pouchitis is inflammation that can occur in a surgically created pouch after having your large intestine removed. […] Pouchitis is thought to be fairly common in people with an ileal pouch. It is believed up to 45% of people with a J-pouch will experience pouchitis in the 10 years after their operation, with 15% 1 year after and 33% 5 years after. […] It isnt known exactly what causes pouchitis but it tends to occur in people who have ulcerative colitis or another form of colitis (such as indeterminate colitis).

• #3 Pouchitis – Wikipedia

  https://en.wikipedia.org/wiki/Pouchitis

  Pouchitis is an umbrella term for inflammation of the ileal pouch, an artificial rectum surgically created out of ileum (the last section of the small intestine) in patients who have undergone a proctocolectomy or total colectomy (removal of the colon and rectum). […] A variety of mechanisms can be the cause of pouchitis including inflammatory factors such as a dysbiosis sparked inflammation or Crohn’s disease of the pouch, surgical causes including surgical join leaks and pelvic sepsis, or infectious from Clostridioides difficile (C Diff) or Cytomegalovirus (CMV). It is possible to have more than one factor causing pouch inflammation at the same time. […] The incidence of a first episode of pouchitis at 1, 5 and 10 years post-operatively is 15%, 33%, and 45% respectively.

• #4 Chronic pouchitis: what every gastroenterologist needs to know | Frontline Gastroenterology

  https://fg.bmj.com/content/16/2/143

  Chronic pouchitis is a complication after restorative proctocolectomy with ileal pouch-anal anastomosis in ulcerative colitis (UC) and patients with familial adenomatous polyposis. […] The pathogenesis of chronic pouchitis involves genetic, immunological, microbial and environmental factors. […] The aetiology of pouchitis remains poorly understood, but likely involves a complex interplay of host genetics, microbiome and the environment, and proinflammatory processes. […] Chronic pouchitis is multifactorial, involving a complex interplay of immunological, genetic, microbial and environmental factors. […] Immune dysregulation, including impaired T-cell homeostasis and cytokine imbalance, plays a significant role, with alterations in mucosal immunity and inflammation contributing to the development of chronic inflammation in the ileal pouch.

• #5 Pouchitis: Clinical Features, Diagnosis, and Treatment | IJGM

  https://www.dovepress.com/pouchitis-clinical-features-diagnosis-and-treatment-peer-reviewed-fulltext-article-IJGM

  Pouchitis is a non-specific inflammation of the ileal reservoir, and the most common, inflammatory and long-term, complication after pouch surgery for ulcerative colitis. The aetiology is still unknown, but many risk factors have been individuated. […] The aetiology of pouchitis is still unknown, and is likely to be multifactorial; it is supposed that a close interaction between the host immune response and the microbiota play a substantial role. […] Reported risk factors for pouchitis include, being a non-smoker extensive UC, backwash ileitis, extraintestinal manifestations (EIMs) especially primary sclerosing cholangitis (PSC), regular use of non-steroidal anti-inflammatory drugs (NSAIDs), and concomitant autoimmune disorders. […] Secondary causes may include inflammatory pouch disorders (eg, CD, cuffitis, pouch anastomotic sinus, pouch fistula), infection with specific pathogens (eg, cytomegalovirus, Clostridioides difficile); vascular or mechanical factors (such as ischaemia, prolapse and pouch obstruction), nonsteroidal anti-inflammatory drug use, autoimmune-associated (eg, IgG4-associated, PSC-associated).

• #6 Pouchitis: What It Is, Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/15484-pouchitis

  Pouchitis is related to changes in the different types of gut bacteria in your pouch. […] This alone may trigger your immune system to think you have an infection and then, produce an inflammatory response. […] Certain types of bacteria in your gut will try to take over if they have the opportunity. These are called pathogenic bacteria. […] An episode of pouchitis is a common occurrence shortly after ileal pouch surgery. […] This happens when certain bacteria continue to dominate other types, which never return to their full strength. […] Antibiotic-resistant pouchitis is a chronic condition that may have a variety of contributing causes. […] Pouchitis is far more common in people who had proctocolectomy surgery to treat inflammatory bowel diseases, such as ulcerative colitis and Crohn’s disease.

• #7 The bacterial pathogenesis and treatment of pouchitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3002591/

  An abnormal host-microbial interaction has long been implicated in all forms of IBD including pouchitis. There is evidence from clinical practice to implicate bacteria in pouchitis. […] The results from culture-based studies of pouch microbiota using culture methods are varied and inconclusive. Advances in our understanding of gut microbiota following the introduction of molecular techniques have led to the realization that culture-based techniques are inadequate for the study of gut microbiota. The findings of the most recent study suggest that a reduction in bacterial diversity but not dysbiosis occurs in pouchitis and that UC RPC patients have a different, less-diverse microbiota with increased Proteobacteria and reduced Bacteroidetes and F. prausnitzii.

• #8 The bacterial pathogenesis and treatment of pouchitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3002591/

  An abnormal host-microbial interaction has long been implicated in all forms of IBD including pouchitis. There is evidence from clinical practice to implicate bacteria in pouchitis. […] The results from culture-based studies of pouch microbiota using culture methods are varied and inconclusive. Advances in our understanding of gut microbiota following the introduction of molecular techniques have led to the realization that culture-based techniques are inadequate for the study of gut microbiota. The findings of the most recent study suggest that a reduction in bacterial diversity but not dysbiosis occurs in pouchitis and that UC RPC patients have a different, less-diverse microbiota with increased Proteobacteria and reduced Bacteroidetes and F. prausnitzii.

• #9 The bacterial pathogenesis and treatment of pouchitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3002591/

  An abnormal host-microbial interaction has long been implicated in all forms of IBD including pouchitis. There is evidence from clinical practice to implicate bacteria in pouchitis. […] The results from culture-based studies of pouch microbiota using culture methods are varied and inconclusive. Advances in our understanding of gut microbiota following the introduction of molecular techniques have led to the realization that culture-based techniques are inadequate for the study of gut microbiota. The findings of the most recent study suggest that a reduction in bacterial diversity but not dysbiosis occurs in pouchitis and that UC RPC patients have a different, less-diverse microbiota with increased Proteobacteria and reduced Bacteroidetes and F. prausnitzii.

• #10 The bacterial pathogenesis and treatment of pouchitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3002591/

  An abnormal host-microbial interaction has long been implicated in all forms of IBD including pouchitis. There is evidence from clinical practice to implicate bacteria in pouchitis. […] The results from culture-based studies of pouch microbiota using culture methods are varied and inconclusive. Advances in our understanding of gut microbiota following the introduction of molecular techniques have led to the realization that culture-based techniques are inadequate for the study of gut microbiota. The findings of the most recent study suggest that a reduction in bacterial diversity but not dysbiosis occurs in pouchitis and that UC RPC patients have a different, less-diverse microbiota with increased Proteobacteria and reduced Bacteroidetes and F. prausnitzii.

• #11 The bacterial pathogenesis and treatment of pouchitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3002591/

  An abnormal host-microbial interaction has long been implicated in all forms of IBD including pouchitis. There is evidence from clinical practice to implicate bacteria in pouchitis. […] The results from culture-based studies of pouch microbiota using culture methods are varied and inconclusive. Advances in our understanding of gut microbiota following the introduction of molecular techniques have led to the realization that culture-based techniques are inadequate for the study of gut microbiota. The findings of the most recent study suggest that a reduction in bacterial diversity but not dysbiosis occurs in pouchitis and that UC RPC patients have a different, less-diverse microbiota with increased Proteobacteria and reduced Bacteroidetes and F. prausnitzii.

• #12 Pouchitis, a complication associated with the surgical treatment of ulcerative colitis. Diagnosis and treatment. Review

  http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0120-99572021000100065

  Pouchitis, a complication associated with the surgical treatment of ulcerative colitis. Diagnosis and treatment. Review […] The exact pathophysiological mechanisms that cause pouchitis are unknown. However, it is more likely to be a multifactorial disease involving genetic predisposition, bacterial overgrowth and dysbiosis in the ileal pouch, among others. […] Recently, it has been found that in acute pouchitis cases there is an increase of species of the Clostridia genus and, reciprocally, its decrease is associated with response to antibiotic treatment. In contrast, in chronic pouchitis cases there is an increase in the amount of Staphylococcus aureus. Other factors involved in its development may include decreased short-chain fatty acids, nutritional deficiencies, ischemia or immune response alterations.

• #13 Pouchitis, a complication associated with the surgical treatment of ulcerative colitis. Diagnosis and treatment. Review

  http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0120-99572021000100065

  Pouchitis, a complication associated with the surgical treatment of ulcerative colitis. Diagnosis and treatment. Review […] The exact pathophysiological mechanisms that cause pouchitis are unknown. However, it is more likely to be a multifactorial disease involving genetic predisposition, bacterial overgrowth and dysbiosis in the ileal pouch, among others. […] Recently, it has been found that in acute pouchitis cases there is an increase of species of the Clostridia genus and, reciprocally, its decrease is associated with response to antibiotic treatment. In contrast, in chronic pouchitis cases there is an increase in the amount of Staphylococcus aureus. Other factors involved in its development may include decreased short-chain fatty acids, nutritional deficiencies, ischemia or immune response alterations.

• #14 Navigating Chronic Pouchitis: Pathogenesis, Diagnosis, and Management – Gastroenterology & Hepatology

  https://www.gastroenterologyandhepatology.net/archives/january-2025/navigating-chronic-pouchitis-pathogenesis-diagnosis-and-management/

  Chronic pouchitis affects 13% to 17% of patients with ileal pouch–anal anastomosis and ulcerative colitis, and 20% with a history of acute pouchitis. […] Pathogenesis of chronic pouchitis can range from microbially mediated to more antibiotic-resistant and immune-mediated processes. […] Pouchitis is thought to result from disrupted innate immunity and a dysregulated adaptive immune response to altered pouch microbiota in susceptible hosts. It represents a disease spectrum, typically starting as acute antibiotic-responsive and then progressing to antibiotic-dependent and finally antibiotic-refractory disease. This progression suggests that etiopathogenesis evolves from microbially mediated inflammation to predominantly immune-mediated inflammation. […] The role of pouch microbiota in mediating pouchitis is supported by pouchitis onset only after continuity is restored and the pouch mucosa is exposed to feces, the correlation of certain microbial groups and reduced diversity with pouchitis and disease activity, and the effectiveness of antibiotics in treating acute pouchitis.

• #15 Review article: the pathogenesis of pouchitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5785099/

  The pathogenesis of pouchitis is not well defined although multiple etiologies have been suggested, including: bacterial dysbiosis, SCFA deprivation, immune dysregulation, reoccurrence of ulcerative colitis, mucosal ischemia and oxygen free radical injury, and genetic susceptibility. Development of pouchitis probably results from an interplay of several of these factors. Importantly, the relative contribution of these multiple processes may differ from individual to individual. […] One line of thinking suggests that pouchitis is a recurrence of the underlying UC disease within the neorectum. […] These data provide evidence to support the hypothesis that pouchitis may actually be a recurrence of UC, likely due to the development of a colonic-like morphology, and possibly a recurring compromised mucus barrier. […] The inflammatory response in pouchitis is interesting since both UC and FAP patients undergo the same surgery but only UC patients commonly develop pouchitis, suggesting that the underlying inflammatory disease in UC patients may be a contributing factor to pouchitis pathogenesis.

• #16 Pouchitis: Symptoms, Causes, Diagnosis, and Treatment

  https://www.verywellhealth.com/pouchitis-8364291

  Pouchitis is an inflammation that occurs in some people who have had ileal pouch-anal anastomosis (IPAA) surgery. […] It is still not entirely understood, but some things are known about why it happens and how to treat it. […] Its not well understood what causes pouchitis, but it is thought to be a group of conditions with multiple causes. […] Pouchitis is more common in people who have had the surgery for ulcerative colitis than those who have it done for other conditions, such as FAP. For this reason, one theory is that it could be a continuation of ulcerative colitis. […] Dysbiosis, meaning an imbalance in the bacteria that live in the intestine and the pouch (the microbiome), may be another cause. Autoimmune conditions that affect the gastrointestinal system, such as ulcerative colitis, can also be a cause. […] For some people, there could be more than one cause that leads to a bout of pouchitis. It is a complicated disorder.

• #17 Chronic pouchitis: what every gastroenterologist needs to know | Frontline Gastroenterology

  https://fg.bmj.com/content/16/2/143

  Chronic pouchitis is a complication after restorative proctocolectomy with ileal pouch-anal anastomosis in ulcerative colitis (UC) and patients with familial adenomatous polyposis. […] The pathogenesis of chronic pouchitis involves genetic, immunological, microbial and environmental factors. […] The aetiology of pouchitis remains poorly understood, but likely involves a complex interplay of host genetics, microbiome and the environment, and proinflammatory processes. […] Chronic pouchitis is multifactorial, involving a complex interplay of immunological, genetic, microbial and environmental factors. […] Immune dysregulation, including impaired T-cell homeostasis and cytokine imbalance, plays a significant role, with alterations in mucosal immunity and inflammation contributing to the development of chronic inflammation in the ileal pouch.

• #18 Diet and Microbiota Modulation for Chronic Pouchitis: Evidence, Challenges, and Opportunities

  https://www.mdpi.com/2072-6643/16/24/4337

  Chronic pouchitis occurs in about 50% of patients undergoing a restorative proctocolectomy for ulcerative colitis. […] Pouchitis is characterized by a remarkable pro-inflammatory state that is detectable both in the microbial and immune compartment. In fact, pouch dysbacteriosis has been associated both with the onset and severity of chronic pouchitis. […] The inflammatory environment that is established within the mucosa of patients with pouchitis is witnessed by recent studies employing single cells RNA sequencing. […] A cytokine storm (IL-1beta, IL-6, IL-8 and TNF-alpha), with the gain of function mutations in IL1β and the disruption of intestinal barrier, complete the picture of mucosal inflammation in pouchitis. […] Among the approaches with an indirect effect on gut microbiota and intestinal inflammation, dietary strategies could play a role. Several dietary approaches have shown promise in improving symptoms and reducing disease burden in patients with chronic pouchitis.

• #19 Diet and Microbiota Modulation for Chronic Pouchitis: Evidence, Challenges, and Opportunities

  https://www.mdpi.com/2072-6643/16/24/4337

  Chronic pouchitis occurs in about 50% of patients undergoing a restorative proctocolectomy for ulcerative colitis. […] Pouchitis is characterized by a remarkable pro-inflammatory state that is detectable both in the microbial and immune compartment. In fact, pouch dysbacteriosis has been associated both with the onset and severity of chronic pouchitis. […] The inflammatory environment that is established within the mucosa of patients with pouchitis is witnessed by recent studies employing single cells RNA sequencing. […] A cytokine storm (IL-1beta, IL-6, IL-8 and TNF-alpha), with the gain of function mutations in IL1β and the disruption of intestinal barrier, complete the picture of mucosal inflammation in pouchitis. […] Among the approaches with an indirect effect on gut microbiota and intestinal inflammation, dietary strategies could play a role. Several dietary approaches have shown promise in improving symptoms and reducing disease burden in patients with chronic pouchitis.

• #20 Diet and Microbiota Modulation for Chronic Pouchitis: Evidence, Challenges, and Opportunities

  https://www.mdpi.com/2072-6643/16/24/4337

  Chronic pouchitis occurs in about 50% of patients undergoing a restorative proctocolectomy for ulcerative colitis. […] Pouchitis is characterized by a remarkable pro-inflammatory state that is detectable both in the microbial and immune compartment. In fact, pouch dysbacteriosis has been associated both with the onset and severity of chronic pouchitis. […] The inflammatory environment that is established within the mucosa of patients with pouchitis is witnessed by recent studies employing single cells RNA sequencing. […] A cytokine storm (IL-1beta, IL-6, IL-8 and TNF-alpha), with the gain of function mutations in IL1β and the disruption of intestinal barrier, complete the picture of mucosal inflammation in pouchitis. […] Among the approaches with an indirect effect on gut microbiota and intestinal inflammation, dietary strategies could play a role. Several dietary approaches have shown promise in improving symptoms and reducing disease burden in patients with chronic pouchitis.

• #21 Pouchitis, a complication associated with the surgical treatment of ulcerative colitis. Diagnosis and treatment. Review

  http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0120-99572021000100065

  The use of nonsteroidal anti-inflammatory drugs (NSAIDs) increases this risk 3.24 times (95 % confidence interval [CI] 1.71-6.13). […] Similar to ulcerative colitis, smoking has been found to have a negative association and smoking cessation increases the risk of pouchitis. […] When primary sclerosing cholangitis and UC occur concurrently, there is a higher risk of pouchitis than when UC occurs alone. […] High levels of perinuclear fluorescence pattern anti-neutrophil cytoplasmic antibody (p-ANCA) represent a risk of pouchitis of 8.5. […] According to a recent meta-analysis, the presence of p-ANCA was associated with increased risk of chronic pouchitis (Odds ratio [OR]: 1.8; 95 % CI: 1.2-2.6), but it was not associated with acute pouchitis. […] Pouchitis diagnosis is made based on the combination of clinical manifestations, endoscopic alterations (pouchoscopy) and histological findings.

• #22 Navigating Chronic Pouchitis: Pathogenesis, Diagnosis, and Management – Gastroenterology & Hepatology

  https://www.gastroenterologyandhepatology.net/archives/january-2025/navigating-chronic-pouchitis-pathogenesis-diagnosis-and-management/

  Disrupted innate immunity is further upregulated in chronic pouchitis. […] A dysregulated immune response in chronic pouchitis is suggested by several studies and supported by the effectiveness of immunosuppressive treatments such as the α4β7 integrin inhibitor vedolizumab. […] Predicting which patients with pouches will develop chronic pouchitis is difficult but important for risk stratification and targeting modifiable risk factors to prevent or delay progression. […] Multiple studies show that early-onset pouchitis predicts chronic pouchitis. […] Prolonged antibiotic use may lead to dysbiosis and disease progression in pouchitis. […] There is a higher prevalence of pelvic dyssynergia in patients with chronic pouchitis, suggesting a positive association. […] Chronic pouchitis is a challenging and common complication of IPAA, with pathogenesis evolving from microbially mediated antibiotic-sensitive to antibiotic-resistant and immune-mediated processes.

• #23 Review article: the pathogenesis of pouchitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5785099/

  The pathogenesis of pouchitis is not well defined although multiple etiologies have been suggested, including: bacterial dysbiosis, SCFA deprivation, immune dysregulation, reoccurrence of ulcerative colitis, mucosal ischemia and oxygen free radical injury, and genetic susceptibility. Development of pouchitis probably results from an interplay of several of these factors. Importantly, the relative contribution of these multiple processes may differ from individual to individual. […] One line of thinking suggests that pouchitis is a recurrence of the underlying UC disease within the neorectum. […] These data provide evidence to support the hypothesis that pouchitis may actually be a recurrence of UC, likely due to the development of a colonic-like morphology, and possibly a recurring compromised mucus barrier. […] The inflammatory response in pouchitis is interesting since both UC and FAP patients undergo the same surgery but only UC patients commonly develop pouchitis, suggesting that the underlying inflammatory disease in UC patients may be a contributing factor to pouchitis pathogenesis.

• #24 Pouchitis: Symptoms, Causes, Diagnosis, and Treatment

  https://www.verywellhealth.com/pouchitis-8364291

  Pouchitis is an inflammation that occurs in some people who have had ileal pouch-anal anastomosis (IPAA) surgery. […] It is still not entirely understood, but some things are known about why it happens and how to treat it. […] Its not well understood what causes pouchitis, but it is thought to be a group of conditions with multiple causes. […] Pouchitis is more common in people who have had the surgery for ulcerative colitis than those who have it done for other conditions, such as FAP. For this reason, one theory is that it could be a continuation of ulcerative colitis. […] Dysbiosis, meaning an imbalance in the bacteria that live in the intestine and the pouch (the microbiome), may be another cause. Autoimmune conditions that affect the gastrointestinal system, such as ulcerative colitis, can also be a cause. […] For some people, there could be more than one cause that leads to a bout of pouchitis. It is a complicated disorder.

• #25 Review article: the pathogenesis of pouchitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5785099/

  A total proctocolectomy followed by ileal pouch-anal anastomosis (IPAA) is a potentially curative surgery for ulcerative colitis (UC) or familial adenomatous polyposis (FAP). About 5-35% of UC patients and 0-11% of FAP patients develop subsequent inflammation of the ileal pouch termed pouchitis. […] The pathogenesis of pouchitis is not definitively understood, but various hypotheses have been proposed, including: 1) recurrence of UC, 2) dysbiosis of the ileal pouch microbiota, 3) deprivation of nutritional short chain fatty acids, 4) mucosal ischemia and oxygen free radical injury, 5) host genetic susceptibility, and 6) immune dysregulation. However, none of these alone are able to fully explain pouchitis pathogenesis. […] Pouchitis, similar to IBD, is a complex disorder that is not caused by any one single factor. More likely, pouchitis occurs through a combination of both dysregulated host inflammatory mechanisms and interaction with luminal microbiota.

• #26 The bacterial pathogenesis and treatment of pouchitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3002591/

  Restorative proctocolectomy (RPC) with ileal pouch-anal anastomosis is the operation of choice for patients with ulcerative colitis. Pouchitis is the most common cause of pouch dysfunction. Although the pathogenesis of this disease is not well understood, bacteria have been implicated in the disease process. In this article we review the aetiology of pouchitis and the evidenced-based treatment options. […] The aetiology of pouchitis […] Similarly to UC and Crohns disease (CD) the mucosal inflammation that occurs in pouchitis is localized to the areas with the highest concentration of bacteria. There is a tenfold increased risk of pouchitis in patients who undergo RPC for UC compared with FAP. Therefore, it has been suggested that pouchitis represents reactivation of UC in the colonized small bowel of the pouch.

• #27 Histopathological evaluation and risk factors related to the development of pouchitis in patients with ileal pouches for ulcerative colitis | Clinics

  https://www.elsevier.es/en-revista-clinics-22-articulo-histopathological-evaluation-risk-factors-related-S1807593222017616

  Many changes in mucosal morphology are observed following ileal pouch construction, including colonic metaplasia and dysplasia. […] Although the physiopathology of pouchitis remains controversial, there is strong evidence that this condition represents a reactivation of UC. […] In particular, pouchitis occurs almost exclusively in patients who underwent IPAA for UC, rather than for FAP, which suggests an autoimmune etiology for this condition in genetically predisposed individuals. […] Other factors in support of this theory include the existence of extra-intestinal events associated with an increased risk of developing pouchitis and the endoscopic and histopathological similarities observed between patients with pouchitis and those with UC. […] There is also an increased risk for the development of pouchitis in female patients and in those with extensive or severe UC, extra-intestinal manifestations, early disease onset, the use of non-steroidal anti-inflammatory drugs, gene polymorphisms in the interleukin-1 receptor and TNF-1 antagonists and the presence of perinuclear anti-neutrophil cytoplasmic antibodies (pANCA).

• #28 Review article: the pathogenesis of pouchitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5785099/

  The pathogenesis of pouchitis is not well defined although multiple etiologies have been suggested, including: bacterial dysbiosis, SCFA deprivation, immune dysregulation, reoccurrence of ulcerative colitis, mucosal ischemia and oxygen free radical injury, and genetic susceptibility. Development of pouchitis probably results from an interplay of several of these factors. Importantly, the relative contribution of these multiple processes may differ from individual to individual. […] One line of thinking suggests that pouchitis is a recurrence of the underlying UC disease within the neorectum. […] These data provide evidence to support the hypothesis that pouchitis may actually be a recurrence of UC, likely due to the development of a colonic-like morphology, and possibly a recurring compromised mucus barrier. […] The inflammatory response in pouchitis is interesting since both UC and FAP patients undergo the same surgery but only UC patients commonly develop pouchitis, suggesting that the underlying inflammatory disease in UC patients may be a contributing factor to pouchitis pathogenesis.

• #29 Histopathological evaluation and risk factors related to the development of pouchitis in patients with ileal pouches for ulcerative colitis | Clinics

  https://www.elsevier.es/en-revista-clinics-22-articulo-histopathological-evaluation-risk-factors-related-S1807593222017616

  Additionally, colonic metaplasia is a common histopathological finding for the ileal pouch and is observed in approximately 50% of patients with pouchitis and approximately 18% of patients undergoing IPAA without pouchitis. […] The degree of mucosal atrophy, the presence of colonic metaplasia, and the degree of acute or chronic inflammation do not appear to constitute risk factors for the development of pouchitis. […] Moreover, we observed that longer postoperative follow-up times were associated with greater degrees of mucosal atrophy.

• #30 Histopathological evaluation and risk factors related to the development of pouchitis in patients with ileal pouches for ulcerative colitis | Clinics

  https://www.elsevier.es/en-revista-clinics-22-articulo-histopathological-evaluation-risk-factors-related-S1807593222017616

  Many changes in mucosal morphology are observed following ileal pouch construction, including colonic metaplasia and dysplasia. […] Although the physiopathology of pouchitis remains controversial, there is strong evidence that this condition represents a reactivation of UC. […] In particular, pouchitis occurs almost exclusively in patients who underwent IPAA for UC, rather than for FAP, which suggests an autoimmune etiology for this condition in genetically predisposed individuals. […] Other factors in support of this theory include the existence of extra-intestinal events associated with an increased risk of developing pouchitis and the endoscopic and histopathological similarities observed between patients with pouchitis and those with UC. […] There is also an increased risk for the development of pouchitis in female patients and in those with extensive or severe UC, extra-intestinal manifestations, early disease onset, the use of non-steroidal anti-inflammatory drugs, gene polymorphisms in the interleukin-1 receptor and TNF-1 antagonists and the presence of perinuclear anti-neutrophil cytoplasmic antibodies (pANCA).

• #31 Histopathological evaluation and risk factors related to the development of pouchitis in patients with ileal pouches for ulcerative colitis | Clinics

  https://www.elsevier.es/en-revista-clinics-22-articulo-histopathological-evaluation-risk-factors-related-S1807593222017616

  Additionally, colonic metaplasia is a common histopathological finding for the ileal pouch and is observed in approximately 50% of patients with pouchitis and approximately 18% of patients undergoing IPAA without pouchitis. […] The degree of mucosal atrophy, the presence of colonic metaplasia, and the degree of acute or chronic inflammation do not appear to constitute risk factors for the development of pouchitis. […] Moreover, we observed that longer postoperative follow-up times were associated with greater degrees of mucosal atrophy.

• #32

  https://link.springer.com/article/10.1007/BF02049401

  Transient mucosal ischemia may cause oxygen-derived free radical production by xanthine oxidase, precipitating pouchitis after ileal pouch-anal anastomosis. […] These data support a role for mucosal ischemia and oxygen free radical production in the etiology of pouchitis.

• #33 Pouchitis: Clinical Features, Diagnosis, and Treatment | IJGM

  https://www.dovepress.com/pouchitis-clinical-features-diagnosis-and-treatment-peer-reviewed-fulltext-article-IJGM

  Ischemia is frequent, and it is characterized by asymmetric inflammation of the pouch with a clear limit with the non-inflamed pouch mucosa. […] Risk factors include male gender and obesity; ischemic pouchitis can be very challenging to treat and most of the patients do not respond to antibiotic therapy. […] Clostridioides difficile infection (CDI) is more common cause of refractory pouchitis than cytomegalovirus (CMV) infection reaching 11%; CDI in patients who underwent pouch surgery is very often refractory or recurrent. […] Use of NSAIDs after pouch surgery postoperatively, is associated with acute and chronic pouchitis. […] A subgroup of patients with pouchitis has concurrent immune-mediated conditions including primary sclerosing cholangitis (PSC), seropositivity for immunoglobulin G4 (IgG4) and infiltration of IgG4-expressing plasma cells in the pouch mucosa.

• #34 Pouchitis: Clinical Features, Diagnosis, and Treatment | IJGM

  https://www.dovepress.com/pouchitis-clinical-features-diagnosis-and-treatment-peer-reviewed-fulltext-article-IJGM

  Ischemia is frequent, and it is characterized by asymmetric inflammation of the pouch with a clear limit with the non-inflamed pouch mucosa. […] Risk factors include male gender and obesity; ischemic pouchitis can be very challenging to treat and most of the patients do not respond to antibiotic therapy. […] Clostridioides difficile infection (CDI) is more common cause of refractory pouchitis than cytomegalovirus (CMV) infection reaching 11%; CDI in patients who underwent pouch surgery is very often refractory or recurrent. […] Use of NSAIDs after pouch surgery postoperatively, is associated with acute and chronic pouchitis. […] A subgroup of patients with pouchitis has concurrent immune-mediated conditions including primary sclerosing cholangitis (PSC), seropositivity for immunoglobulin G4 (IgG4) and infiltration of IgG4-expressing plasma cells in the pouch mucosa.

• #35 Pouchitis: Symptoms, Causes, and Treatment

  https://www.medicoverhospitals.in/diseases/pouchitis/

  The etiology of pouchitis remains multifactorial and somewhat elusive, involving a complex interplay of genetic, environmental, and immunological factors. […] Research indicates that individuals with certain genetic markers may be more susceptible to developing pouchitis. […] A significant contributing factor is an imbalance in the gut microbiota, known as dysbiosis. […] Pouchitis is also associated with an abnormal immune response. The body’s immune system may mistakenly attack the cells lining the ileal pouch, leading to inflammation and other symptoms. […] It is caused by inflammation of the ileal pouch.

• #36 Diagnosis and Medical Treatment of Acute and Chronic Idiopathic Pouchitis in Inflammatory Bowel Disease

  https://www.mdpi.com/1648-9144/60/6/979

  Pouchitis is classified into either idiopathic (primary) or secondary, according to the cause. […] The etiology of primary or idiopathic pouchitis is not clearly defined but it is thought that dysbiosis plays an important role. Pouch construction determines local fecal stasis that leads to colonic metaplasia in the initial small bowel mucosa of the pouch that promotes an abnormal immune response in genetically predisposed organisms, which leads to inflammation; a similar mechanism that it is seen in UC. […] Risk factors that were identified to be associated with pouchitis include the following: extensive UC and backwash ileitis before colectomy; the presence of extraintestinal manifestations; non-smoker status; IL-1 receptor antagonist gene polymorphism; and the presence of pANCA (antineutrophil cytoplasmic antibodies).

• #37 Inflammatory pouch disease: The spectrum of pouchitis

  https://www.wjgnet.com/1007-9327/full/v21/i29/8739.htm

  In the majority of patients with pouchitis, the etiology and pathogenesis are not clear and the disease is identified as idiopathic pouchitis. The pathogenesis of pouchitis in these patients may be triggered by dysbiosis, leading to an altered mucosal immune response. […] Current evidence suggests that the interactions of the altered composition and/or the quantity of the luminal microbiota (dysbiosis), with the altered characteristics of the mucosa (colonic metaplasia), in conjunction with abnormalities of innate and adaptive mucosal immunity, play a key role in the pathogenesis of pouchitis. […] Reported risk factors for pouchitis include genetic susceptibility (polymorphisms of IL-1ra and NOD2/CARD15, non-carrier status of TNF allele 2), extensive UC, backwash ileitis, preoperative thrombocytosis or corticosteroid use, extraintestinal manifestations, especially PSC, the presence of p-ANCA, non-smoking status, and the use of NSAIDs.

• #38 Pouchitis: Clinical Features, Diagnosis, and Treatment | IJGM

  https://www.dovepress.com/pouchitis-clinical-features-diagnosis-and-treatment-peer-reviewed-fulltext-article-IJGM

  Once secondary pouchitis is ruled-out a diagnosis of CARP is made. […] Pouchitis is the most common long-term complication of IPAA, and is a syndrome including many different diseases. Etiology in unknown but dysbiosis has a key role in the disease initiation and development. Risk factors include NOD2/CARD15 mutation, being a non-smoker, extensive UC, backwash ileitis, extraintestinal manifestations (EIM) especially PSC, regular use of NSAIDs, and concomitant autoimmune disorders.

• #39 Inflammatory pouch disease: The spectrum of pouchitis

  https://www.wjgnet.com/1007-9327/full/v21/i29/8739.htm

  In the majority of patients with pouchitis, the etiology and pathogenesis are not clear and the disease is identified as idiopathic pouchitis. The pathogenesis of pouchitis in these patients may be triggered by dysbiosis, leading to an altered mucosal immune response. […] Current evidence suggests that the interactions of the altered composition and/or the quantity of the luminal microbiota (dysbiosis), with the altered characteristics of the mucosa (colonic metaplasia), in conjunction with abnormalities of innate and adaptive mucosal immunity, play a key role in the pathogenesis of pouchitis. […] Reported risk factors for pouchitis include genetic susceptibility (polymorphisms of IL-1ra and NOD2/CARD15, non-carrier status of TNF allele 2), extensive UC, backwash ileitis, preoperative thrombocytosis or corticosteroid use, extraintestinal manifestations, especially PSC, the presence of p-ANCA, non-smoking status, and the use of NSAIDs.

• #40 Inflammatory pouch disease: The spectrum of pouchitis

  https://www.wjgnet.com/1007-9327/full/v21/i29/8739.htm

  In the majority of patients with pouchitis, the etiology and pathogenesis are not clear and the disease is identified as idiopathic pouchitis. The pathogenesis of pouchitis in these patients may be triggered by dysbiosis, leading to an altered mucosal immune response. […] Current evidence suggests that the interactions of the altered composition and/or the quantity of the luminal microbiota (dysbiosis), with the altered characteristics of the mucosa (colonic metaplasia), in conjunction with abnormalities of innate and adaptive mucosal immunity, play a key role in the pathogenesis of pouchitis. […] Reported risk factors for pouchitis include genetic susceptibility (polymorphisms of IL-1ra and NOD2/CARD15, non-carrier status of TNF allele 2), extensive UC, backwash ileitis, preoperative thrombocytosis or corticosteroid use, extraintestinal manifestations, especially PSC, the presence of p-ANCA, non-smoking status, and the use of NSAIDs.

• #41 Inflammatory pouch disease: The spectrum of pouchitis

  https://www.wjgnet.com/1007-9327/full/v21/i29/8739.htm

  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). […] Pouchitis is a common complication in patients with IPAA, but the term is nonspecific, and encompasses a variety of etiologies and pathogenesis. […] This suggests that the pathogenetic background of UC may contribute significantly to the development of pouchitis. […] Based on etiology, we can identify 2 main diagnostic pouchitis groups – idiopathic and secondary. In idiopathic pouchitis, the etiology and pathogenesis are unclear, while in secondary pouchitis, there is an association with a specific causative or pathogenetic factor. […] Secondary pouchitis occurs in up to 30% of cases and can be infectious, ischemic, non-steroidal anti-inflammatory drug (NSAID)-induced, collagenous, autoimmune-associated, or due to Crohns disease.

• #42 Pouchitis: Clinical Features, Diagnosis, and Treatment | IJGM

  https://www.dovepress.com/pouchitis-clinical-features-diagnosis-and-treatment-peer-reviewed-fulltext-article-IJGM

  Ischemia is frequent, and it is characterized by asymmetric inflammation of the pouch with a clear limit with the non-inflamed pouch mucosa. […] Risk factors include male gender and obesity; ischemic pouchitis can be very challenging to treat and most of the patients do not respond to antibiotic therapy. […] Clostridioides difficile infection (CDI) is more common cause of refractory pouchitis than cytomegalovirus (CMV) infection reaching 11%; CDI in patients who underwent pouch surgery is very often refractory or recurrent. […] Use of NSAIDs after pouch surgery postoperatively, is associated with acute and chronic pouchitis. […] A subgroup of patients with pouchitis has concurrent immune-mediated conditions including primary sclerosing cholangitis (PSC), seropositivity for immunoglobulin G4 (IgG4) and infiltration of IgG4-expressing plasma cells in the pouch mucosa.

• #43 C. difficile Infection in Patients with Pouchitislogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b

  https://www.jwatch.org/jg200808150000003/2008/08/15/c-difficile-infection-patients-with-pouchitis

  Concurrent C. difficile infection might be a cause of refractory pouchitis. […] Refractory pouchitis has multiple causes, one of which might be concurrent Clostridium difficile infection (CDI; Dig Dis Sci 2006: 51:2361). […] CDI was associated with male sex and with left-sided colitis prior to colectomy (vs. pancolitis), but not with inpatient versus outpatient status, proton-pump–inhibitor use, immunomodulator use, corticosteroid use, or recent or remote antibiotic use. […] Overall, CDI was not associated with increased symptom scores or abnormal endoscopy scores on the Pouchitis Disease Activity Index; however, six cases showed improvement in pouch inflammation after eradication of CDI. […] These data suggest that isolation of C. difficile in pouchitis patients is frequently possible. Sometimes the infection might be an “innocent bystander,” yet eradication results in improvement in some symptomatic patients.

• #44 Pouchitis: What It Is, Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/15484-pouchitis

  Some bacterial infections are resistant to antibiotic treatment, like C. difficile. […] Sometimes, it’s a viral infection, like cytomegalovirus, or a fungal infection, like candidiasis, that produces an inflammatory response in your pouch. […] Certain preexisting medical conditions or medications that you take can repress your immune system, which weakens your defenses against infections. […] Taking too many NSAIDs (nonsteroidal anti-inflammatory drugs, like aspirin and ibuprofen) too often can erode your gut lining, including your pouch lining. […] This is an autoimmune disease that causes chronic inflammation in your biliary tract.

• #45

  https://journals.lww.com/ajg/fulltext/2017/10001/pouchitis_caused_bysalmonellabraenderup_infection_.2400.aspx

  Pouchitis can be secondary to infectious causes; commonly cited organisms include cytomegalovirus, Clostridium difficile, and Candida albicans. […] Pouchitis can be caused by infections, ischemia, medications and inflammatory bowel disease. […] Infectious pouchitis is thought to be secondary to alterations in the fecal microbiota due to fecal stasis within the pouch and broad spectrum antibiotics are usually indicated unless fecal cultures are positive for a specific pathogen. […] Salmonella has rarely been described to cause pouchitis. […] Pouchitis secondary to Salmonella Braenderup has not been described previously in literature.

• #46 Pouchitis: What It Is, Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/15484-pouchitis

  Some bacterial infections are resistant to antibiotic treatment, like C. difficile. […] Sometimes, it’s a viral infection, like cytomegalovirus, or a fungal infection, like candidiasis, that produces an inflammatory response in your pouch. […] Certain preexisting medical conditions or medications that you take can repress your immune system, which weakens your defenses against infections. […] Taking too many NSAIDs (nonsteroidal anti-inflammatory drugs, like aspirin and ibuprofen) too often can erode your gut lining, including your pouch lining. […] This is an autoimmune disease that causes chronic inflammation in your biliary tract.

• #47

  https://journals.lww.com/ajg/fulltext/2017/10001/pouchitis_caused_bysalmonellabraenderup_infection_.2400.aspx

  Pouchitis can be secondary to infectious causes; commonly cited organisms include cytomegalovirus, Clostridium difficile, and Candida albicans. […] Pouchitis can be caused by infections, ischemia, medications and inflammatory bowel disease. […] Infectious pouchitis is thought to be secondary to alterations in the fecal microbiota due to fecal stasis within the pouch and broad spectrum antibiotics are usually indicated unless fecal cultures are positive for a specific pathogen. […] Salmonella has rarely been described to cause pouchitis. […] Pouchitis secondary to Salmonella Braenderup has not been described previously in literature.

• #48

  https://journals.lww.com/ajg/fulltext/2017/10001/pouchitis_caused_bysalmonellabraenderup_infection_.2400.aspx

  Pouchitis can be secondary to infectious causes; commonly cited organisms include cytomegalovirus, Clostridium difficile, and Candida albicans. […] Pouchitis can be caused by infections, ischemia, medications and inflammatory bowel disease. […] Infectious pouchitis is thought to be secondary to alterations in the fecal microbiota due to fecal stasis within the pouch and broad spectrum antibiotics are usually indicated unless fecal cultures are positive for a specific pathogen. […] Salmonella has rarely been described to cause pouchitis. […] Pouchitis secondary to Salmonella Braenderup has not been described previously in literature.

• #49 Pouchitis: What It Is, Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/15484-pouchitis

  Some bacterial infections are resistant to antibiotic treatment, like C. difficile. […] Sometimes, it’s a viral infection, like cytomegalovirus, or a fungal infection, like candidiasis, that produces an inflammatory response in your pouch. […] Certain preexisting medical conditions or medications that you take can repress your immune system, which weakens your defenses against infections. […] Taking too many NSAIDs (nonsteroidal anti-inflammatory drugs, like aspirin and ibuprofen) too often can erode your gut lining, including your pouch lining. […] This is an autoimmune disease that causes chronic inflammation in your biliary tract.

• #50 Mayo Clinic Health Library – Pouchitis | Swiss Medical Network

  https://www.swissmedical.net/en/healtcare-library/con-20306105

  Pouchitis is a complication of J-pouch surgery. It happens in nearly one-half of the people who have the procedure. […] The cause of pouchitis is unknown. The condition appears to be due to an interaction between bacteria in the pouch and an underlying issue with the immune system. […] Pouchitis happens more often in people who have underlying IBD, such as ulcerative colitis. […] Taking NSAIDS, such as ibuprofen (Advil, Motrin IB) and naproxen sodium (Aleve), can contribute to the development of pouchitis. […] Radiation therapy in the pelvic area increases the risk of getting pouchitis.

• #51 Pouchitis, a complication associated with the surgical treatment of ulcerative colitis. Diagnosis and treatment. Review

  http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0120-99572021000100065

  The use of nonsteroidal anti-inflammatory drugs (NSAIDs) increases this risk 3.24 times (95 % confidence interval [CI] 1.71-6.13). […] Similar to ulcerative colitis, smoking has been found to have a negative association and smoking cessation increases the risk of pouchitis. […] When primary sclerosing cholangitis and UC occur concurrently, there is a higher risk of pouchitis than when UC occurs alone. […] High levels of perinuclear fluorescence pattern anti-neutrophil cytoplasmic antibody (p-ANCA) represent a risk of pouchitis of 8.5. […] According to a recent meta-analysis, the presence of p-ANCA was associated with increased risk of chronic pouchitis (Odds ratio [OR]: 1.8; 95 % CI: 1.2-2.6), but it was not associated with acute pouchitis. […] Pouchitis diagnosis is made based on the combination of clinical manifestations, endoscopic alterations (pouchoscopy) and histological findings.

• #52 Risk factors associated with the development of chronic pouchitis following ileal-pouch anal anastomosis surgery for ulcerative colitis

  https://www.wjgnet.com/2308-3840/full/v13/i1/101226.htm

  Chronic pouchitis remains a significant and prevalent complication following ileal pouch-anal anastomosis in patients with ulcerative colitis. […] To identify potential risk factors for the development of chronic pouchitis. […] Extraintestinal manifestation [odds ratio (OR) = 2.11, 95% confidence intervals (CI): 1.53-2.91, P0.001,I2 = 0%], specifically primary sclerosing cholangitis (PSC) (OR = 3.69, 95%CI: 1.40-9.21, P= 0.01,I2 = 48%), and extensive colitis (OR = 1.96, 95%CI: 1.23-3.11, P= 0.00,I2 = 31%) were associated with an increased risk of chronic pouchitis. […] Other factors, including gender, smoking status, family history of inflammatory bowel disease and ileal pouch anal anastomosis surgical indication were not significantly associated with chronic pouchitis. […] Extraintestinal manifestations, PSC and extensive colitis are associated with the development of chronic pouchitis.

• #53 Risk factors associated with the development of chronic pouchitis following ileal-pouch anal anastomosis surgery for ulcerative colitis

  https://www.wjgnet.com/2308-3840/full/v13/i1/101226.htm

  Multiple risk factors for the development of chronic pouchitis have been investigated, including smoking history, male gender, extensive colitis, primary sclerosing cholangitis (PSC), and indication of IPAA surgery. […] Our study corroborates previous findings that extraintestinal manifestations, specifically PSC, are risk factors for chronic pouchitis. […] Additionally, we identified extensive colitis as a pre-operative risk factor for chronic pouchitis, suggesting disease severity may influence its development. […] The precise mechanisms underlying chronic pouchitis remain elusive. However, accumulating evidence suggests that certain serological markers, microbial dysbiosis and genetic polymorphisms may contribute to its development.

• #54 Pouchitis: Clinical Features, Diagnosis, and Treatment | IJGM

  https://www.dovepress.com/pouchitis-clinical-features-diagnosis-and-treatment-peer-reviewed-fulltext-article-IJGM

  Ischemia is frequent, and it is characterized by asymmetric inflammation of the pouch with a clear limit with the non-inflamed pouch mucosa. […] Risk factors include male gender and obesity; ischemic pouchitis can be very challenging to treat and most of the patients do not respond to antibiotic therapy. […] Clostridioides difficile infection (CDI) is more common cause of refractory pouchitis than cytomegalovirus (CMV) infection reaching 11%; CDI in patients who underwent pouch surgery is very often refractory or recurrent. […] Use of NSAIDs after pouch surgery postoperatively, is associated with acute and chronic pouchitis. […] A subgroup of patients with pouchitis has concurrent immune-mediated conditions including primary sclerosing cholangitis (PSC), seropositivity for immunoglobulin G4 (IgG4) and infiltration of IgG4-expressing plasma cells in the pouch mucosa.

• #55 Risk factors associated with the development of chronic pouchitis following ileal-pouch anal anastomosis surgery for ulcerative colitis

  https://www.wjgnet.com/2308-3840/full/v13/i1/101226.htm

  Chronic pouchitis remains a significant and prevalent complication following ileal pouch-anal anastomosis in patients with ulcerative colitis. […] To identify potential risk factors for the development of chronic pouchitis. […] Extraintestinal manifestation [odds ratio (OR) = 2.11, 95% confidence intervals (CI): 1.53-2.91, P0.001,I2 = 0%], specifically primary sclerosing cholangitis (PSC) (OR = 3.69, 95%CI: 1.40-9.21, P= 0.01,I2 = 48%), and extensive colitis (OR = 1.96, 95%CI: 1.23-3.11, P= 0.00,I2 = 31%) were associated with an increased risk of chronic pouchitis. […] Other factors, including gender, smoking status, family history of inflammatory bowel disease and ileal pouch anal anastomosis surgical indication were not significantly associated with chronic pouchitis. […] Extraintestinal manifestations, PSC and extensive colitis are associated with the development of chronic pouchitis.

• #56 Risk factors associated with the development of chronic pouchitis following ileal-pouch anal anastomosis surgery for ulcerative colitis

  https://www.wjgnet.com/2308-3840/full/v13/i1/101226.htm

  Chronic pouchitis remains a significant and prevalent complication following ileal pouch-anal anastomosis in patients with ulcerative colitis. […] To identify potential risk factors for the development of chronic pouchitis. […] Extraintestinal manifestation [odds ratio (OR) = 2.11, 95% confidence intervals (CI): 1.53-2.91, P0.001,I2 = 0%], specifically primary sclerosing cholangitis (PSC) (OR = 3.69, 95%CI: 1.40-9.21, P= 0.01,I2 = 48%), and extensive colitis (OR = 1.96, 95%CI: 1.23-3.11, P= 0.00,I2 = 31%) were associated with an increased risk of chronic pouchitis. […] Other factors, including gender, smoking status, family history of inflammatory bowel disease and ileal pouch anal anastomosis surgical indication were not significantly associated with chronic pouchitis. […] Extraintestinal manifestations, PSC and extensive colitis are associated with the development of chronic pouchitis.

• #57 Pouchitis: Symptoms, Causes, Diagnosis, Treatments

  https://www.webmd.com/ibd-crohns-disease/ulcerative-colitis/what-is-pouchitis

  In as many as half the cases, the pouch that replaced your rectum eventually gets infected or inflamed. This complication is called pouchitis. […] Researchers aren’t sure what triggers pouchitis. But more and more, they suspect that your gut health may play a key role. One theory is that the mix of good and bad bacteria in your stomach could pave the way for bacterial, fungal, or viral infections that may lead to pouchitis. […] Other possible risk factors include: Extensive ulcerative colitis, Inflammatory polyps, or growths, in the pouch, Taking nonsteroidal anti-inflammatory drugs (NSAIDs), Weak blood flow to the area, Inflamed or hardened bile ducts in the liver, Smoking, Genetics.

• #58 Understanding Pouchitis | Saint Luke’s Health System

  https://www.saintlukeskc.org/health-library/understanding-pouchitis

  Experts arent quite sure what causes pouchitis. […] But after J-pouch surgery, bacteria that live in the gut change. The immune system may react to this change. This may cause the inflammation. […] You may be at a higher risk of getting pouchitis after J-pouch surgery if you: Have ulcerative colitis, Have chronic liver disease, Have a viral or bacterial infection, Smoke, Take nonsteroidal anti-inflammatory drugs (NSAIDs), Are male, Have had belly surgery in the past.

• #59 Pouchitis, a complication associated with the surgical treatment of ulcerative colitis. Diagnosis and treatment. Review

  http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0120-99572021000100065

  The use of nonsteroidal anti-inflammatory drugs (NSAIDs) increases this risk 3.24 times (95 % confidence interval [CI] 1.71-6.13). […] Similar to ulcerative colitis, smoking has been found to have a negative association and smoking cessation increases the risk of pouchitis. […] When primary sclerosing cholangitis and UC occur concurrently, there is a higher risk of pouchitis than when UC occurs alone. […] High levels of perinuclear fluorescence pattern anti-neutrophil cytoplasmic antibody (p-ANCA) represent a risk of pouchitis of 8.5. […] According to a recent meta-analysis, the presence of p-ANCA was associated with increased risk of chronic pouchitis (Odds ratio [OR]: 1.8; 95 % CI: 1.2-2.6), but it was not associated with acute pouchitis. […] Pouchitis diagnosis is made based on the combination of clinical manifestations, endoscopic alterations (pouchoscopy) and histological findings.

• #60 Pouchitis – Causes, Symptoms, Diagnosis, and Treatment

  https://www.apollohospitals.com/diseases-and-conditions/pouchitis

  Pouchitis can be triggered by infectious agents, including bacteria, viruses, or fungi. The altered anatomy of the gastrointestinal tract after pouch surgery can lead to changes in the gut microbiome, making it susceptible to infections. Environmental factors, such as exposure to certain medications or dietary components, may also play a role in the development of pouchitis. […] There is evidence to suggest that genetic predisposition may contribute to the development of pouchitis. Individuals with a family history of inflammatory bowel disease (IBD) may be at a higher risk. Additionally, pouchitis may have an autoimmune component, where the body’s immune system mistakenly attacks the pouch, leading to inflammation. […] Diet and lifestyle choices can influence the risk of developing pouchitis. High-fat diets, excessive alcohol consumption, and smoking have been associated with an increased risk. Conversely, a diet rich in fiber and low in processed foods may help reduce the risk of inflammation. […] Pouchitis can be caused by infections, autoimmune responses, genetic factors, and lifestyle choices, including diet and smoking.

• #61 Mayo Clinic Health Library – Pouchitis | Swiss Medical Network

  https://www.swissmedical.net/en/healtcare-library/con-20306105

  Pouchitis is a complication of J-pouch surgery. It happens in nearly one-half of the people who have the procedure. […] The cause of pouchitis is unknown. The condition appears to be due to an interaction between bacteria in the pouch and an underlying issue with the immune system. […] Pouchitis happens more often in people who have underlying IBD, such as ulcerative colitis. […] Taking NSAIDS, such as ibuprofen (Advil, Motrin IB) and naproxen sodium (Aleve), can contribute to the development of pouchitis. […] Radiation therapy in the pelvic area increases the risk of getting pouchitis.

• #62 SciELO Brazil – DIAGNOSTIC AND MANAGEMENT APPROACH TO POUCHITIS IN INFLAMMATORY BOWEL DISEASE DIAGNOSTIC AND MANAGEMENT APPROACH TO POUCHITIS IN INFLAMMATORY BOWEL DISEASE

  https://www.scielo.br/j/ag/a/TR4Vb4DGXdH6D7Zw4RVHgKg/?lang=en

  In general, episodes of pouchitis are more associated with colectomy due to UC, than to neoplastic or familial polyposic syndromes. […] Although the pathogenesis of pouchitis is not yet clear, multiple factors have been involved in its development and evolution. […] Ischemic or mechanical post-surgical phenomena, immunological alterations, and dysbiotics processes have also been evidenced. […] Primary or idiopathic pouchitis is characterized by the difficulty to investigate a triggering factor of the condition. […] Secondary pouchitis may have several etiologies being the most frequent: […] Infectious pouchitis […] Immunomediated pouchitis […] Ischemic pouchitis […] Crohns disease of the pouch […] Neoplasia […] Chronic pouchitis can be classified into two entities: chronic antibiotic-dependent pouchitis, where pouchitis recurs at least three times a year after discontinuing antibiotic therapy, and chronic antibiotic-refractory pouchitis, when the condition does not respond to antibiotic therapy. […] When pouchitis do not respond to antibiotic/probiotic therapy, and the condition persists for more than four weeks, it is called chronic pouchitis, which occurs in 10%-15% of all cases.

• #63 What Is Pouchitis and How Can It Be Prevented?

  https://www.everydayhealth.com/ibd/living-with-pouchitis/

  Just a couple of months after her last surgery, in October 2019, she experienced her first of many bouts of pouchitis, a common complication of the procedure. […] The cause of pouchitis is not entirely known, but its believed it may be an immune response to the different types of bacteria that collect in the pouch. Genetics, being a smoker, long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs), and conditions like heart disease and diabetes may also increase the risk of pouchitis, according to the Cleveland Clinic. […] Some patients do go on to develop chronic pouchitis, in which the condition recurs multiple times shortly after symptom relief from prescription probiotics and antibiotics. […] Chronic pouchitis can be more difficult to treat and requires the patient to stay on probiotics or a nonabsorbable antibiotic for long periods of time.

• #64 SciELO Brazil – DIAGNOSTIC AND MANAGEMENT APPROACH TO POUCHITIS IN INFLAMMATORY BOWEL DISEASE DIAGNOSTIC AND MANAGEMENT APPROACH TO POUCHITIS IN INFLAMMATORY BOWEL DISEASE

  https://www.scielo.br/j/ag/a/TR4Vb4DGXdH6D7Zw4RVHgKg/?lang=en

  In general, episodes of pouchitis are more associated with colectomy due to UC, than to neoplastic or familial polyposic syndromes. […] Although the pathogenesis of pouchitis is not yet clear, multiple factors have been involved in its development and evolution. […] Ischemic or mechanical post-surgical phenomena, immunological alterations, and dysbiotics processes have also been evidenced. […] Primary or idiopathic pouchitis is characterized by the difficulty to investigate a triggering factor of the condition. […] Secondary pouchitis may have several etiologies being the most frequent: […] Infectious pouchitis […] Immunomediated pouchitis […] Ischemic pouchitis […] Crohns disease of the pouch […] Neoplasia […] Chronic pouchitis can be classified into two entities: chronic antibiotic-dependent pouchitis, where pouchitis recurs at least three times a year after discontinuing antibiotic therapy, and chronic antibiotic-refractory pouchitis, when the condition does not respond to antibiotic therapy. […] When pouchitis do not respond to antibiotic/probiotic therapy, and the condition persists for more than four weeks, it is called chronic pouchitis, which occurs in 10%-15% of all cases.

• #65 Treatment Options For Pouchitis – Klarity Health Library

  https://my.klarity.health/treatment-options-for-pouchitis/

  Viral infections and fungal infections, which can cause inflammatory reactions in the pouch, are other possible causes. Immunosuppressive diseases and treatments can also reduce immunity, making a person more vulnerable to infections. Prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs) can also damage the lining of the pouch. […] After an ileal pouch surgery, early-onset pouchitis is frequently noticed, although it usually resolves with medication; it can happen again, resulting in recurring episodes. In more severe cases, this can progress to chronic antibiotic-dependent pouchitis (CADP) or, in certain people, chronic antibiotic-resistant pouchitis (CARP), in which the effectiveness of antibiotics gradually wears off.

• #66 Navigating Chronic Pouchitis: Pathogenesis, Diagnosis, and Management – Gastroenterology & Hepatology

  https://www.gastroenterologyandhepatology.net/archives/january-2025/navigating-chronic-pouchitis-pathogenesis-diagnosis-and-management/

  Chronic pouchitis affects 13% to 17% of patients with ileal pouch–anal anastomosis and ulcerative colitis, and 20% with a history of acute pouchitis. […] Pathogenesis of chronic pouchitis can range from microbially mediated to more antibiotic-resistant and immune-mediated processes. […] Pouchitis is thought to result from disrupted innate immunity and a dysregulated adaptive immune response to altered pouch microbiota in susceptible hosts. It represents a disease spectrum, typically starting as acute antibiotic-responsive and then progressing to antibiotic-dependent and finally antibiotic-refractory disease. This progression suggests that etiopathogenesis evolves from microbially mediated inflammation to predominantly immune-mediated inflammation. […] The role of pouch microbiota in mediating pouchitis is supported by pouchitis onset only after continuity is restored and the pouch mucosa is exposed to feces, the correlation of certain microbial groups and reduced diversity with pouchitis and disease activity, and the effectiveness of antibiotics in treating acute pouchitis.

• #67 Navigating Chronic Pouchitis: Pathogenesis, Diagnosis, and Management – Gastroenterology & Hepatology

  https://www.gastroenterologyandhepatology.net/archives/january-2025/navigating-chronic-pouchitis-pathogenesis-diagnosis-and-management/

  Disrupted innate immunity is further upregulated in chronic pouchitis. […] A dysregulated immune response in chronic pouchitis is suggested by several studies and supported by the effectiveness of immunosuppressive treatments such as the α4β7 integrin inhibitor vedolizumab. […] Predicting which patients with pouches will develop chronic pouchitis is difficult but important for risk stratification and targeting modifiable risk factors to prevent or delay progression. […] Multiple studies show that early-onset pouchitis predicts chronic pouchitis. […] Prolonged antibiotic use may lead to dysbiosis and disease progression in pouchitis. […] There is a higher prevalence of pelvic dyssynergia in patients with chronic pouchitis, suggesting a positive association. […] Chronic pouchitis is a challenging and common complication of IPAA, with pathogenesis evolving from microbially mediated antibiotic-sensitive to antibiotic-resistant and immune-mediated processes.

• #68 Inflammatory pouch disease: The spectrum of pouchitis

  https://www.wjgnet.com/1007-9327/full/v21/i29/8739.htm

  Autoimmune pouchitis includes the PSC-associated and IgG4-associated forms of pouchitis. […] Crohns disease of the pouch can occur in patients with prior Crohns colitis without previous small intestinal or perianal disease. More interestingly, Crohns disease of the pouch can develop de novo in UC patients after colectomy with IPAA.

• #69 Unpacking the Complexities of Chronic J-Pouch Conditions – Advances in Gastroenterology and GI Surgery | NewYork-Presbyterian

  https://www.nyp.org/advances/article/gastroenterology/unpacking-the-complexities-of-chronic-j-pouch-conditions

  Dr. Schwartzberg is passionate about educating gastroenterologists and colorectal surgeons about other potential causes for pouch issues. […] If someone is having symptoms that are consistent with pouch failurewe start from scratch. […] Patients who have years of normal pouch function, and then develop symptoms, may in fact have Crohns of the pouch, and medical therapy might be the appropriate treatment. […] However, patients who developed symptoms within a year or two after pouch surgery often have a mechanical/structural complication that can be corrected with surgery, a redo pouch. […] The reason for the need for experienced, multidisciplinary care is because of the complicated and confusing ways these complications can present. […] Some people have a leak at the tip of J-pouch, which creates a very insidious infection, he says.

• #70 Unpacking the Complexities of Chronic J-Pouch Conditions – Advances in Gastroenterology and GI Surgery | NewYork-Presbyterian

  https://www.nyp.org/advances/article/gastroenterology/unpacking-the-complexities-of-chronic-j-pouch-conditions

  Dr. Schwartzberg is passionate about educating gastroenterologists and colorectal surgeons about other potential causes for pouch issues. […] If someone is having symptoms that are consistent with pouch failurewe start from scratch. […] Patients who have years of normal pouch function, and then develop symptoms, may in fact have Crohns of the pouch, and medical therapy might be the appropriate treatment. […] However, patients who developed symptoms within a year or two after pouch surgery often have a mechanical/structural complication that can be corrected with surgery, a redo pouch. […] The reason for the need for experienced, multidisciplinary care is because of the complicated and confusing ways these complications can present. […] Some people have a leak at the tip of J-pouch, which creates a very insidious infection, he says.

• #71 Unpacking the Complexities of Chronic J-Pouch Conditions – Advances in Gastroenterology and GI Surgery | NewYork-Presbyterian

  https://www.nyp.org/advances/article/gastroenterology/unpacking-the-complexities-of-chronic-j-pouch-conditions

  Its very hard to identify but once you do, it can be fixed without a fill pouch mobilization, and this may not even require a temporary ileostomy. […] Another example of a complex pouch condition is pouch-twist. […] In this scenario, you must completely mobilize the pouch, disconnect the pouch from the anal canal, untwist it and reconnect it in the proper orientation. […] Thus, avoiding a permanent stoma for the patient.

• #72 It’s complicated: living with pouchitis and cuffitis

  https://crohnsandcolitis.org.uk/news-stories/blog-posts/its-complicated-living-with-pouchitis-and-cuffitis

  Living with Crohn’s or Colitis can present many challenges and sometimes results in specific medical complications, such as pouchitis and cuffitis. […] Unfortunately, since her surgery, Alwine has had both cuffitis and pouchitis inflammation of the rectal cuff as well as the J-pouch. […] Alwine’s consultant had told her that pouchitis was also a risk but usually treatable. However, the pain and nausea from the conditions has never really gone. […] With pouchitis, the pouch which collects stools before they are passed has become inflamed. […] Cuffitis is inflammation of the rectal cuff that links an ileo-anal pouch with the anal tissue. […] Most recently, she has been prescribed mesalazine suppositories and been told that the ongoing issue is mainly cuffitis with mild pouchitis. […] While my experience has not been good, she says, I would still stress and reassure people that pouchitis or cuffitis are not common complications and most people only ever have one or two episodes in their lifetime.

• #73 Navigating Chronic Pouchitis: Pathogenesis, Diagnosis, and Management – Gastroenterology & Hepatology

  https://www.gastroenterologyandhepatology.net/archives/january-2025/navigating-chronic-pouchitis-pathogenesis-diagnosis-and-management/

  Disrupted innate immunity is further upregulated in chronic pouchitis. […] A dysregulated immune response in chronic pouchitis is suggested by several studies and supported by the effectiveness of immunosuppressive treatments such as the α4β7 integrin inhibitor vedolizumab. […] Predicting which patients with pouches will develop chronic pouchitis is difficult but important for risk stratification and targeting modifiable risk factors to prevent or delay progression. […] Multiple studies show that early-onset pouchitis predicts chronic pouchitis. […] Prolonged antibiotic use may lead to dysbiosis and disease progression in pouchitis. […] There is a higher prevalence of pelvic dyssynergia in patients with chronic pouchitis, suggesting a positive association. […] Chronic pouchitis is a challenging and common complication of IPAA, with pathogenesis evolving from microbially mediated antibiotic-sensitive to antibiotic-resistant and immune-mediated processes.

• #74 Unpacking the Complexities of Chronic J-Pouch Conditions – Advances in Gastroenterology and GI Surgery | NewYork-Presbyterian

  https://www.nyp.org/advances/article/gastroenterology/unpacking-the-complexities-of-chronic-j-pouch-conditions

  While pouchitis and pouch failure can occur in patients with a J-pouch, many times there are underlying causes of these conditions that can be treated if they are recognized. […] Potential abdominal causes of these symptoms include afferent loop syndrome, anastomotic stricture at the ileostomy closure site, a non-functional side-to-side stapled ileostomy closure site, chronic adhesive bowel obstruction, and intestinal fistulae from post-operative abdominal complications. […] This small retrospective review showed that we need to be thinking about abdominal issues and not jump directly to labeling everything as pouch failure, says Dr. Schwartzberg. […] These patients had abdominal issues, such as a stricture or scar tissue causing a chronic obstruction, but, because these patients have a pelvic pouch, its immediately labeled as a pouch issue and basically all efforts are forgone to identify anything other than a pouch problem.

• #75 Review article: the pathogenesis of pouchitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5785099/

  Pouchitis suggests itself to be a heterogeneous disease. Clinical, endoscopic, and histological presentation is often dissimilar from patient to patient, presumably reflecting variation in host susceptibility and possibly varying exposure to other factors affecting the disease. Pouchitis is probably a widely variable disease process and the term pouchitis might be viewed better as an umbrella term used to describe multiple differing pathologies that end commonly with inflammation of the ileal pouch. This review will discuss six of the main proposed pathogenic mechanisms of pouchitis: (1) recurrence of UC in the colon-like ileal reservoir, (2) dysbiosis of the ileal pouch microbiota, (3) SCFA deprivation, (4) mucosal ischemia and oxygen free radical injury, (5) genetic predisposition, and (6) immune dysregulation.

• #76 Review article: the pathogenesis of pouchitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5785099/

  The pathogenesis of pouchitis is not well defined although multiple etiologies have been suggested, including: bacterial dysbiosis, SCFA deprivation, immune dysregulation, reoccurrence of ulcerative colitis, mucosal ischemia and oxygen free radical injury, and genetic susceptibility. Development of pouchitis probably results from an interplay of several of these factors. Importantly, the relative contribution of these multiple processes may differ from individual to individual. […] One line of thinking suggests that pouchitis is a recurrence of the underlying UC disease within the neorectum. […] These data provide evidence to support the hypothesis that pouchitis may actually be a recurrence of UC, likely due to the development of a colonic-like morphology, and possibly a recurring compromised mucus barrier. […] The inflammatory response in pouchitis is interesting since both UC and FAP patients undergo the same surgery but only UC patients commonly develop pouchitis, suggesting that the underlying inflammatory disease in UC patients may be a contributing factor to pouchitis pathogenesis.

• #77 Review article: the pathogenesis of pouchitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5785099/

  Pouchitis suggests itself to be a heterogeneous disease. Clinical, endoscopic, and histological presentation is often dissimilar from patient to patient, presumably reflecting variation in host susceptibility and possibly varying exposure to other factors affecting the disease. Pouchitis is probably a widely variable disease process and the term pouchitis might be viewed better as an umbrella term used to describe multiple differing pathologies that end commonly with inflammation of the ileal pouch. This review will discuss six of the main proposed pathogenic mechanisms of pouchitis: (1) recurrence of UC in the colon-like ileal reservoir, (2) dysbiosis of the ileal pouch microbiota, (3) SCFA deprivation, (4) mucosal ischemia and oxygen free radical injury, (5) genetic predisposition, and (6) immune dysregulation.

• #78 Diagnosis and Medical Treatment of Acute and Chronic Idiopathic Pouchitis in Inflammatory Bowel Disease

  https://www.mdpi.com/1648-9144/60/6/979

  Pouchitis is classified into either idiopathic (primary) or secondary, according to the cause. […] The etiology of primary or idiopathic pouchitis is not clearly defined but it is thought that dysbiosis plays an important role. Pouch construction determines local fecal stasis that leads to colonic metaplasia in the initial small bowel mucosa of the pouch that promotes an abnormal immune response in genetically predisposed organisms, which leads to inflammation; a similar mechanism that it is seen in UC. […] Risk factors that were identified to be associated with pouchitis include the following: extensive UC and backwash ileitis before colectomy; the presence of extraintestinal manifestations; non-smoker status; IL-1 receptor antagonist gene polymorphism; and the presence of pANCA (antineutrophil cytoplasmic antibodies).

• #79 Diet and Microbiota Modulation for Chronic Pouchitis: Evidence, Challenges, and Opportunities

  https://www.mdpi.com/2072-6643/16/24/4337

  Adherence to the Mediterranean diet was associated with lower rates of pouchitis. […] The low FODMAP diet is designed to reduce the intake of poorly absorbed short-chain carbohydrates, such as fructose, lactose, fructans, and polyols, which are incompletely digested in the small intestine. […] The Monash Pouch diet aims to address hydrogen sulfide (H2S) production and rectify short-chain fatty acid (SCFA) deficiencies by modulating pouch fermentation pathways and sulfate dissimilatory reduction. […] Despite current evidence, the clinical application of nutritional and microbial therapies in chronic pouchitis faces several obstacles. […] Further well-designed research is essential to address these gaps, optimize therapeutic strategies, and better integrate these innovative approaches into clinical practice.

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