Pouchitis

Idiopathic and aspecific inflammation of the reservoir (pouchitis) is the most frequent and disturbing complication after IPAA [6, 7]. The cumulative risk of developing one or more episodes of pouchitis with rather serious symptoms requiring specific treatment is 50% after 5 years and in progressive relation with the length of follow-up [6,67]. The rarity of this occurrence in patients suffering from FAP (3-14%) and the increased incidence in patients suffering from sclerosing cholangitis support the theory of pouchitis as a new form of intestinal inflammatory disease specific to the reservoir [68]. Usually pouchi-tis has a favourable course and quick response to antibiotics. Less than 10% of patients suffer from chronic disorders with difficult therapeutic control. Untreatable forms leading to reservoir excision are about 0.3-1.3% [67,68]. Recent observations showed the effectiveness of probiotics in maintaining remission after antibiotic therapy and as a prophylaxis against pouchitis development in the first year after reservoir construction [69]. The effects of pouchitis on functional results have not been completely clarified even if some authors associate this complication with metabolic sequelae and significantly diminished quality of life [70].

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