Pouchitis

Overview

Mayo Clinic has significant expertise and experience in treating pouchitis. Mayo offers the latest in screening and diagnostic services for pouchitis. A team of gastroenterologists, colorectal surgeons, radiologists and pathologists help patients choose the best options for their situations. Mayo physicians are researching methods to improve treatment of this condition.

Diagnosis

The diagnosis of pouchitis is based on a combination of exams, including endoscopies (to look inside the pouch), biopsies and, in some cases, X-rays to rule out Crohn's disease or other conditions. Upon diagnosis, patients may need additional tests to monitor the disease, its complications or the side effects of medications. Some pouchitis patients may also be monitored for precancerous symptoms.

Pouchitis is rated for severity with a standardized index:

• Mild to moderately active: increased stool frequency, urgency, infrequent incontinence
• Severely active: hospitalization for dehydration, frequent incontinence
• Acute: less than 4 weeks
• Chronic: more than 4 weeks
• In remission

Treatment Options

Most patients respond to a short (1-2 weeks) course of antibiotics such as metronidazole and ciprofloxacin. Learn more about pouchitis treatment options.

• Treatment in Arizona
• Treatment in Florida
• Treatment in Minnesota

About Pouchitis

Colostomy-sparing surgery creates a pouch in patients who have part of their colon removed.

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Pouchitis is an inflammation of an internal pouch created in patients who have part of their colon removed to treat ulcerative colitis or familial adenomatous polyposis (FAP). The ileoanal pouch ("pull-through") and the continent ileostomy (Koch pouch) prevent the need to wear an external appliance to collect waste. Instead, the surgeon uses part of the patient's small intestine to create an internal pouch for the storage of stool. Sometimes the lining of this internal pouch becomes inflamed. This complication is known as pouchitis. Pouchitis can cause symptoms similar to ulcerative colitis, such as diarrhea, crampy abdominal pain, increased frequency of stool, bleeding, fever, dehydration and joint pain. The condition can usually be managed with a short course of antibiotics.

Thirty-two percent of patients with an ileoanal pouch have had at least one episode of pouchitis. This figure includes patients who have had the pouch anywhere from one year to 14 years. The longer the time since the pouch was created, the more likely that pouchitis will occur: 15 percent of patients will experience pouchitis at one year; 36 percent at five years; and 46 percent at 10 years. These statistics are roughly the same for patients who have Koch pouches.

There is a higher incidence of pouchitis in patients with immunologic skin disease, severe inflammatory joint disease, active smokers or those with a history of primary sclerosing.

Even people who develop pouchitis find that their quality of life is better than when they had ulcerative colitis. Only a small number of patients suffer from chronic pouchitis. In virtually all cases, the problem can be eliminated by converting to a standard ileostomy.

Read more at www.MayoClinic.com (A service of Mayo Foundation for Medical Education and Research).