Objective: Total proctocolectomy with ileal pouch-anal anastomosis has become the preferred surgical procedure for ulcerative colitis. Although most patients report a good functional outcome and significant improvement in their quality of life after ileal pouch-anal anastomosis, pouchitis remains the most common long-term complication. This review highlights significant reports on the diagnosis, treatment, and complications of pouchitis in former ulcerative colitis.

Results: The diagnosis of pouchitis is based on clinical symptoms including increased stool frequency, urgency, rectal bleeding, abdominal cramping, or pelvic discomfort and should be verified by typical findings at endoscopy. Antibiotics such as metronidazole and ciprofloxacin are effective treatments for acute attacks of pouchitis, and for those patients with recurrent or chronic refractory pouchitis, prophylactic therapy with long-term use of the VSL#3 combination of probiotics has now been proved to be highly effective in controlled trials. Most patients with an ileal pouch-anal anastomosis experience a good quality of life, and the risk for removal of the pelvic pouch because of intractable pouchitis is low. Previous reports of neoplastic transformation in certain subgroups of pouch patients have not been substantiated.

Conclusions: Pouchitis is in important clinical entity among ulcerative colitis patients having undergone ileal pouch-anal anastomosis. Diagnosis has become more straightforward, and treatment modalities encompass a variety of remedies, including probiotics. The long-term prognosis is good, and the risk of malignant transformation appears to be very low.