Pouchitis: pathophysiology and treatment

Pouchitis is a potential complication after proctocolectomy and restorative ileoanal anastomosis. It is more frequent in UC than in familial polyposis . Little is known about the etiopathology of pouchitis. Risk factors includ e the presence of extraintestinal manifestations, primary sclerosing cholan gitis, cessation of smoking, and previous course of disease. A host of path ophysiological pathways have been identified as potential mechanisms of pou chitis, which include inflammatory mediators, adhesion molecules, oxygen ra dical species, p-ANCA, and short-chain fatty acids. The microflora in the p ouch may also be an important factor in causing inflammation. The risk of d eveloping cancer in cases of pouchitis has not been established as clearly as in those of UC. Particular attention should be paid to patients who have remaining anorectal mucosa after pouch construction. Experience in the tre atment of chronic relapsing and chronic refractory pouchitis is limited. Th e continuation of conventional anti-inflammatory treatment is successful on ly in a small percentage of patients. New biological response-modifying the rapies which target novel immunoregulatory molecules in IBD will also have impact on the systemic and topical treatment of pouchitis.