Medical Management of Inflammatory Pouch Disorders

Proctocolectomy with ileal pouch-anal anastomosis is the preferred surgical treatment for refractory ulcerative colitis. Pouchitis, defined as inflammation of the ileal pouch, develops in approximately 80% of cases following colectomy. Although most patients will initially respond to antibiotic therapy, recurrence is common, suggesting a more complex pathophysiology beyond the microbiome, similar to what is seen in inflammatory bowel disease. In this review, we provide an overview of inflammatory pouch disorders, including acute pouchitis, chronic antibiotic-dependent pouchitis, chronic antibiotic-refractory pouchitis, Crohn's-like disease of the pouch, and cuffitis, as well as outline a stepwise approach to diagnosis of management. We also highlight future directions and emerging therapies in the field.