Etiology and pathogenesis of pouchitis

Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the preferred surgery for ulcerative colitis (UC) and familial adenomatous polyposis (FAP). While this surgical therapy is effective and results in good clinical outcomes and quality of life, patients experience complications, the most common of which is pouchitis. While most pouchitis is considered idiopathic, there is mounting evidence that pouchitis results from aberrant immune response to the bacterial populations found in the pouch in a genetically predisposed patient. Dysbiosis and decreased diversity of the microbiota seem to contribute to this process. Risk factors for pouchitis including inflammatory bowel disease and obesity provide further clues to the etiology of pouchitis. In conclusion, we seek to understand the pathogenesis of pouchitis as both a post-operative complication and a form of inflammatory bowel disease (IBD).