Many people with serious ulcerative colitis end up having their diseased colon removed and the bowel reconnected with a surgical procedure known asileoanal anastomosis (IPAA) . This surgery creates an internal pouch (from the small intestine) to hold waste before it’s eliminated. Pouchitis is an inflammation of the lining of this pouch. This complication occurs in up to half of people who have this operation. They experience symptoms such as abdominal pain, cramps, increased number of bowel movements and a strong feeling of the need to have a bowel movement.
Most of the time, suspected pouchitis can be accurately diagnosed with the following combination of methods:
- Medical history of symptoms
- Physical examination
- Stool tests for infections
- Endoscopic examination of the pouch
- Biopsy of tissue from the lining of the pouch
The endoscopic exam can also detect cuffitis — an inflammation of the connection created between the intestinal tissue and the anus. Cuffitis is a recurrence of the ulcerative colitis in the small amount of original tissue that remains in most people after the ileoanal anastomosis procedure.
X-rays and a pelvic MRI may be needed to detect other possible causes of symptoms, such as pouch leak.
After diagnosis, additional testing may be needed to monitor the disease, its complications or the side effects of medications. Some people may also be monitored for precancerous changes.
In most cases, a short course (one to two weeks) of antibiotics such as ciprofloxacin or metronidazole will decrease or eliminate the symptoms (remission). Improvement in symptoms usually occurs in one to three days. People generally have fewer side effects with ciprofloxacin, and it may be more effective than metronidazole.
About 10 to 20 percent of people develop chronic pouchitis. Many of these people require long-term continuous antibiotic therapy to maintain remission. Supplements of probiotic bacteria can be helpful in preventing pouchitis from returning once it has been treated.
In some people, pouchitis does not respond to antibiotics (called refractory). . Treatment options include:
- Assuring that there’s not another explanation for your symptoms
- Topical mesalamine (suppository or enema)
- Oral and topical corticosteroids, such as budesonide
- Immunosuppressive medications, such as infliximab
In rare cases when pouchitis does not respond to any medications, it may be necessary to remove the pouch.
Cuffitis is treated with the same medications used to treat ulcerative colitis, most commonly in the form of a mesalamine suppository.