Description

Pouchitis is the swelling and irritation, called inflammation in the lining of a bag made during surgery to remove the colon. The bag is made for the treatment of a bowel disease called ulcerative colitis and some other diseases.

Many people with ulcerative colitis need to have their two points of exit. Surgeons use a procedure called ileoanal anastomosis (J-pouch) surgery to connect the bowel again after taking the colon.

In J-pouch surgery, surgeons use the end of the small intestine, called the ileum, to make a bag shaped like the letter J. Surgeons attach the pouch in the inside of the body to the area just above the anus. The bag contains the stool before it leaves the body.

Pouchitis is a complication of a J-pouch surgery. It occurs in almost half of the people who have the procedure.

Symptoms

The symptoms of pouchitis may include diarrhea, abdominal pain, joint pain, cramps and fever. Other symptoms include passing stool more often, escape of stool in the night, difficulty to control the passage of stool and a strong desire to defecate.

Causes

The cause of pouchitis is unknown. The condition appears to be due to an interaction between the bacteria in the bag and an underlying problem with the immune system.

Risk factors

Some factors that may increase the risk of developing pouchitis include:

  • Have inflammatory bowel disease, also known as IBD. Pouchitis occurs more often in people who have underlying inflammatory bowel disease such as ulcerative colitis.
  • The use of nonsteroidal anti-inflammatory drugs, also called Nsaids. Taking NSAIDS , such as ibuprofen (Advil, Motrin IB) and naproxen sodium (Aleve), may contribute to the development of pouchitis.
  • The radiation therapy. Radiation therapy in the pelvic area increases the risk of developing pouchitis.

Diagnosis

To diagnose pouchitis, a health professional is likely to start by taking a medical history and performing a physical examination.

Confirming the diagnosis may include tests, such as:

  • The laboratory tests. Blood tests may be done to look for other medical conditions. Stool tests may be done to see if there is infection. The results can help to determine what type of antibiotics are the best treatment.
  • Endoscopy. Endoscopy uses a tiny camera on the end of a flexible tube to examine visually the ileal pouch. During the endoscopy, a tissue sample, called a biopsy, may be required for testing.
  • The projection image. A health professional may recommend an imaging test, such as magnetic resonance imaging or computed tomography to find out what is causing the symptoms.

Treatment

Antibiotics

Antibiotics are the most common treatment for pouchitis. Most people get better within 1 to 2 days of starting antibiotics and did not develop pouchitis again. The full course of treatment is usually 10 to 14 days, although as the courses are sometimes required.

Someone who has regular outbreaks of pouchitis may need ongoing maintenance of the antibiotic therapy. The use of probiotics may help to prevent pouchitis back.

Surgery

On rare occasions, the pouchitis does not respond to daily treatment. Then, surgeons may need to remove the pouch and make a permanent ileostomy.

Symptoms and treatment of Pouchitis