IPS is a functional disorder diagnosed in symptomatic patients who suffer mainly from increased bowel frequency, urgency and abdominal pain without endoscopic or histologic evidence of rectal cuff or pouch inflammation . Clinical features overlap with those of pouchitis and resemble those of irritable bowel syndrome. The aetiology is unclear, and is probably multifactorial in nature. Brain-gut factors may play a role in the pathophysiology of IPS. It is currently a diagnosis of exclusion. A recent study by Shen et al.  reported that patients with IPS have significantly poorer quality-of-life scores than patients with normal pouches. Treatment is empiric and symptom oriented. Some authors had reported that dietary modifications, antidiarrhoeal medications (e.g. loperamide) or tricyclic antidepressants might be effective in treating these patients . In our series, the incidence of IPS where patients had symptoms but pouch endoscopy and biopsies did not demonstrate a significant pathology (thus PDAI was <7) was 5.1%.
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