An attractive hypothesis for the pathogenesis of pouchitis is that the pelvic reservoir undergoes a process of colonic metaplasia, possibly as a result of changes in bacterial flora, and that this metaplasia recreates a colon-like environment that favours the recurrence of ulcerative colitis in the ileal reservoir. More worrying perhaps are the long term implications of colonic metaplasia in the reservoir mucosa. The mucosal epithelium of the reservoir shows increased proliferative activity in patients with and without pouchitis.i The coexistence of colonic metaplasia and hyperproliferaton may increase the neoplastic potential of the reservoir's epithelium. In both ulcerative colitis and familial adenomatous polyposis the colonic mucosa shows hyperproliferation,2425 and, al- though to different degrees, both conditions are associated with epithelial dysplasia and malignancy.
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David Slater (1990) studied this question.