Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Pouchitis: Epidemiology, clinical manifestations, and diagnosis

Bo Shen, MD
Section Editor
Paul Rutgeerts, MD, PhD, FRCP
Deputy Editor
Kristen M Robson, MD, MBA, FACG


Pouchitis is the most frequently observed long-term complication of ileal pouch-anal anastomosis or a continent ileostomy (ie, Koch pouch). This topic will review the epidemiology, pathogenesis, clinical manifestations, and diagnosis of pouchitis. The management of pouchitis is discussed in detail, separately. (See "Pouchitis: Management".)


Pouchitis is an inflammatory condition of the ileal pouch reservoir of an ileal pouch-anal anastomosis.

Classification — Pouchitis has been classified as follows [1]:

Based on the duration of symptoms into acute (≤4 weeks) versus chronic (>4 weeks).

Based on response to antibiotics into antibiotic-responsive versus antibiotic-dependent (ie, requiring ongoing antibiotic therapy to keep disease in remission) versus antibiotic-refractory (ie, not responding to a standard course of antibiotic therapy).

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Jan 05, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Pardi DS, D'Haens G, Shen B, et al. Clinical guidelines for the management of pouchitis. Inflamm Bowel Dis 2009; 15:1424.
  2. Lohmuller JL, Pemberton JH, Dozois RR, et al. Pouchitis and extraintestinal manifestations of inflammatory bowel disease after ileal pouch-anal anastomosis. Ann Surg 1990; 211:622.
  3. Mignon M, Stettler C, Phillips SF. Pouchitis--a poorly understood entity. Dis Colon Rectum 1995; 38:100.
  4. Sandborn WJ. Pouchitis following ileal pouch-anal anastomosis: definition, pathogenesis, and treatment. Gastroenterology 1994; 107:1856.
  5. Romanos J, Samarasekera DN, Stebbing JF, et al. Outcome of 200 restorative proctocolectomy operations: the John Radcliffe Hospital experience. Br J Surg 1997; 84:814.
  6. Ståhlberg D, Gullberg K, Liljeqvist L, et al. Pouchitis following pelvic pouch operation for ulcerative colitis. Incidence, cumulative risk, and risk factors. Dis Colon Rectum 1996; 39:1012.
  7. Keränen U, Luukkonen P, Järvinen H. Functional results after restorative proctocolectomy complicated by pouchitis. Dis Colon Rectum 1997; 40:764.
  8. Dozois RR, Goldberg SM, Rothenberger DA, et al. Restorative proctocolectomy with ileal reservoir. Int J Colorectal Dis 1986; 1:2.
  9. Fonkalsrud EW. Endorectal ileoanal anastomosis with isoperistaltic ileal reservoir after colectomy and mucosal proctectomy. Ann Surg 1984; 199:151.
  10. Penna C, Dozois R, Tremaine W, et al. Pouchitis after ileal pouch-anal anastomosis for ulcerative colitis occurs with increased frequency in patients with associated primary sclerosing cholangitis. Gut 1996; 38:234.
  11. Fazio VW, Kiran RP, Remzi FH, et al. Ileal pouch anal anastomosis: analysis of outcome and quality of life in 3707 patients. Ann Surg 2013; 257:679.
  12. Ferrante M, Declerck S, De Hertogh G, et al. Outcome after proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis. Inflamm Bowel Dis 2008; 14:20.
  13. Simchuk EJ, Thirlby RC. Risk factors and true incidence of pouchitis in patients after ileal pouch-anal anastomoses. World J Surg 2000; 24:851.
  14. Hueting WE, Buskens E, van der Tweel I, et al. Results and complications after ileal pouch anal anastomosis: a meta-analysis of 43 observational studies comprising 9,317 patients. Dig Surg 2005; 22:69.
  15. Mahadevan U, Sandborn WJ. Diagnosis and management of pouchitis. Gastroenterology 2003; 124:1636.
  16. Carter MJ, Di Giovine FS, Cox A, et al. The interleukin 1 receptor antagonist gene allele 2 as a predictor of pouchitis following colectomy and IPAA in ulcerative colitis. Gastroenterology 2001; 121:805.
  17. Sehgal R, Berg A, Hegarty JP, et al. NOD2/CARD15 mutations correlate with severe pouchitis after ileal pouch-anal anastomosis. Dis Colon Rectum 2010; 53:1487.
  18. Meier CB, Hegazi RA, Aisenberg J, et al. Innate immune receptor genetic polymorphisms in pouchitis: is CARD15 a susceptibility factor? Inflamm Bowel Dis 2005; 11:965.
  19. Tyler AD, Milgrom R, Stempak JM, et al. The NOD2insC polymorphism is associated with worse outcome following ileal pouch-anal anastomosis for ulcerative colitis. Gut 2013; 62:1433.
  20. Lammers KM, Ouburg S, Morré SA, et al. Combined carriership of TLR9-1237C and CD14-260T alleles enhances the risk of developing chronic relapsing pouchitis. World J Gastroenterol 2005; 11:7323.
  21. Sehgal R, Berg A, Polinski JI, et al. Genetic risk profiling and gene signature modeling to predict risk of complications after IPAA. Dis Colon Rectum 2012; 55:239.
  22. Kabakchiev B, Tyler A, Stempak JM, et al. Downregulation of expression of xenobiotic efflux genes is associated with pelvic pouch inflammation in ulcerative colitis. Inflamm Bowel Dis 2014; 20:1157.
  23. de Silva HJ, Millard PR, Soper N, et al. Effects of the faecal stream and stasis on the ileal pouch mucosa. Gut 1991; 32:1166.
  24. Coffey JC, Rowan F, Burke J, et al. Pathogenesis of and unifying hypothesis for idiopathic pouchitis. Am J Gastroenterol 2009; 104:1013.
  25. Kohyama A, Ogawa H, Funayama Y, et al. Bacterial population moves toward a colon-like community in the pouch after total proctocolectomy. Surgery 2009; 145:435.
  26. Sokol H, Lay C, Seksik P, Tannock GW. Analysis of bacterial bowel communities of IBD patients: what has it revealed? Inflamm Bowel Dis 2008; 14:858.
  27. McLaughlin SD, Walker AW, Churcher C, et al. The bacteriology of pouchitis: a molecular phylogenetic analysis using 16S rRNA gene cloning and sequencing. Ann Surg 2010; 252:90.
  28. Tannock GW, Lawley B, Munro K, et al. Comprehensive analysis of the bacterial content of stool from patients with chronic pouchitis, normal pouches, or familial adenomatous polyposis pouches. Inflamm Bowel Dis 2012; 18:925.
  29. Scarpa M, Grillo A, Faggian D, et al. Relationship between mucosa-associated microbiota and inflammatory parameters in the ileal pouch after restorative proctocolectomy for ulcerative colitis. Surgery 2011; 150:56.
  30. Reshef L, Kovacs A, Ofer A, et al. Pouch Inflammation Is Associated With a Decrease in Specific Bacterial Taxa. Gastroenterology 2015; 149:718.
  31. Morgan XC, Kabakchiev B, Waldron L, et al. Associations between host gene expression, the mucosal microbiome, and clinical outcome in the pelvic pouch of patients with inflammatory bowel disease. Genome Biol 2015; 16:67.
  32. Shen BO, Jiang ZD, Fazio VW, et al. Clostridium difficile infection in patients with ileal pouch-anal anastomosis. Clin Gastroenterol Hepatol 2008; 6:782.
  33. Li Y, Qian J, Queener E, Shen B. Risk factors and outcome of PCR-detected Clostridium difficile infection in ileal pouch patients. Inflamm Bowel Dis 2013; 19:397.
  34. Shen B, Remzi FH, Fazio VW. Fulminant Clostridium difficile-associated pouchitis with a fatal outcome. Nat Rev Gastroenterol Hepatol 2009; 6:492.
  35. Shen B. Campylobacter infection in patients with ileal pouches. Am J Gastroenterol 2010; 105:472.
  36. Lan N, Patil DT, Shen B. Histoplasma capsulatum infection in refractory Crohn's disease of the pouch on anti-TNF biological therapy. Am J Gastroenterol 2013; 108:281.
  37. McCurdy JD, Loftus EV Jr, Tremaine WJ, et al. Cytomegalovirus infection of the ileoanal pouch: clinical characteristics and outcomes. Inflamm Bowel Dis 2013; 19:2394.
  38. Falk A, Olsson C, Ahrné S, et al. Ileal pelvic pouch microbiota from two former ulcerative colitis patients, analysed by DNA-based methods, were unstable over time and showed the presence of Clostridium perfringens. Scand J Gastroenterol 2007; 42:973.
  39. Ingram S, McKinley JM, Vasey F, et al. Are inflammatory bowel disease (IBD) and pouchitis a reactive enteropathy to group D streptococci (Enterococci)? Inflamm Bowel Dis 2009; 15:1609.
  40. Gosselink MP, Schouten WR, van Lieshout LM, et al. Eradication of pathogenic bacteria and restoration of normal pouch flora: comparison of metronidazole and ciprofloxacin in the treatment of pouchitis. Dis Colon Rectum 2004; 47:1519.
  41. Muñoz-Juarez M, Pemberton JH, Sandborn WJ, et al. Misdiagnosis of specific cytomegalovirus infection of the ileoanal pouch as refractory idiopathic chronic pouchitis: report of two cases. Dis Colon Rectum 1999; 42:117.
  42. Moonka D, Furth EE, MacDermott RP, Lichtenstein GR. Pouchitis associated with primary cytomegalovirus infection. Am J Gastroenterol 1998; 93:264.
  43. de Silva HJ, Jones M, Prince C, et al. Lymphocyte and macrophage subpopulations in pelvic ileal pouches. Gut 1991; 32:1160.
  44. Kroesen AJ, Leistenschneider P, Lehmann K, et al. Increased bacterial permeation in long-lasting ileoanal pouches. Inflamm Bowel Dis 2006; 12:736.
  45. Hirata I, Berrebi G, Austin LL, et al. Immunohistological characterization of intraepithelial and lamina propria lymphocytes in control ileum and colon and in inflammatory bowel disease. Dig Dis Sci 1986; 31:593.
  46. Stallmach A, Schäfer F, Hoffmann S, et al. Increased state of activation of CD4 positive T cells and elevated interferon gamma production in pouchitis. Gut 1998; 43:499.
  47. Thomas PD, Forbes A, Nicholls RJ, Ciclitira PJ. Altered expression of the lymphocyte activation markers CD30 and CD27 in patients with pouchitis. Scand J Gastroenterol 2001; 36:258.
  48. Goldberg PA, Herbst F, Beckett CG, et al. Leucocyte typing, cytokine expression, and epithelial turnover in the ileal pouch in patients with ulcerative colitis and familial adenomatous polyposis. Gut 1996; 38:549.
  49. Scarpa M, Grillo A, Pozza A, et al. TLR2 and TLR4 up-regulation and colonization of the ileal mucosa by Clostridiaceae spp. in chronic/relapsing pouchitis. J Surg Res 2011; 169:e145.
  50. Shepherd NA, Healey CJ, Warren BF, et al. Distribution of mucosal pathology and an assessment of colonic phenotypic change in the pelvic ileal reservoir. Gut 1993; 34:101.
  51. Merrett MN, Soper N, Mortensen N, Jewell DP. Intestinal permeability in the ileal pouch. Gut 1996; 39:226.
  52. Toiyama Y, Araki T, Yoshiyama S, et al. The expression patterns of Toll-like receptors in the ileal pouch mucosa of postoperative ulcerative colitis patients. Surg Today 2006; 36:287.
  53. Heuschen G, Leowardi C, Hinz U, et al. Differential expression of toll-like receptor 3 and 5 in ileal pouch mucosa of ulcerative colitis patients. Int J Colorectal Dis 2007; 22:293.
  54. Porter EM, van Dam E, Valore EV, Ganz T. Broad-spectrum antimicrobial activity of human intestinal defensin 5. Infect Immun 1997; 65:2396.
  55. Ayabe T, Satchell DP, Wilson CL, et al. Secretion of microbicidal alpha-defensins by intestinal Paneth cells in response to bacteria. Nat Immunol 2000; 1:113.
  56. Salzman NH, Ghosh D, Huttner KM, et al. Protection against enteric salmonellosis in transgenic mice expressing a human intestinal defensin. Nature 2003; 422:522.
  57. Wehkamp J, Salzman NH, Porter E, et al. Reduced Paneth cell alpha-defensins in ileal Crohn's disease. Proc Natl Acad Sci U S A 2005; 102:18129.
  58. Scarpa M, Grillo A, Scarpa M, et al. Innate immune environment in ileal pouch mucosa: α5 defensin up-regulation as predictor of chronic/relapsing pouchitis. J Gastrointest Surg 2012; 16:188.
  59. Masters SL, Simon A, Aksentijevich I, Kastner DL. Horror autoinflammaticus: the molecular pathophysiology of autoinflammatory disease (*). Annu Rev Immunol 2009; 27:621.
  60. Kiehne K, Brunke G, Wegner F, et al. Defensin expression in chronic pouchitis in patients with ulcerative colitis or familial adenomatous polyposis coli. World J Gastroenterol 2006; 12:1056.
  61. Schmidt C, Giese T, Ludwig B, et al. Increased cytokine transcripts in pouchitis reflect the degree of inflammation but not the underlying entity. Int J Colorectal Dis 2006; 21:419.
  62. Hirata N, Oshitani N, Kamata N, et al. Proliferation of immature plasma cells in pouchitis mucosa in patients with ulcerative colitis. Inflamm Bowel Dis 2008; 14:1084.
  63. Patel RT, Bain I, Youngs D, Keighley MR. Cytokine production in pouchitis is similar to that in ulcerative colitis. Dis Colon Rectum 1995; 38:831.
  64. Gionchetti P, Campieri M, Belluzzi A, et al. Mucosal concentrations of interleukin-1 beta, interleukin-6, interleukin-8, and tumor necrosis factor-alpha in pelvic ileal pouches. Dig Dis Sci 1994; 39:1525.
  65. Bulois P, Tremaine WJ, Maunoury V, et al. Pouchitis is associated with mucosal imbalance between interleukin-8 and interleukin-10. Inflamm Bowel Dis 2000; 6:157.
  66. Patel RT, Pall AA, Adu D, Keighley MR. Circulating soluble adhesion molecules in inflammatory bowel disease. Eur J Gastroenterol Hepatol 1995; 7:1037.
  67. Chaussade S, Denizot Y, Valleur P, et al. Presence of PAF-acether in stool of patients with pouch ileoanal anastomosis and pouchitis. Gastroenterology 1991; 100:1509.
  68. Gertner DJ, Rampton DS, Madden MV, et al. Increased leukotriene B4 release from ileal pouch mucosa in ulcerative colitis compared with familial adenomatous polyposis. Gut 1994; 35:1429.
  69. Romano M, Cuomo A, Tuccillo C, et al. Vascular endothelial growth factor and cyclooxygenase-2 are overexpressed in ileal pouch-anal anastomosis. Dis Colon Rectum 2007; 50:650.
  70. Stucchi AF, Shebani KO, Leeman SE, et al. A neurokinin 1 receptor antagonist reduces an ongoing ileal pouch inflammation and the response to a subsequent inflammatory stimulus. Am J Physiol Gastrointest Liver Physiol 2003; 285:G1259.
  71. Stallmach A, Chan CC, Ecker KW, et al. Comparable expression of matrix metalloproteinases 1 and 2 in pouchitis and ulcerative colitis. Gut 2000; 47:415.
  72. Ulisse S, Gionchetti P, D'Alò S, et al. Expression of cytokines, inducible nitric oxide synthase, and matrix metalloproteinases in pouchitis: effects of probiotic treatment. Am J Gastroenterol 2001; 96:2691.
  73. Achkar JP, Al-Haddad M, Lashner B, et al. Differentiating risk factors for acute and chronic pouchitis. Clin Gastroenterol Hepatol 2005; 3:60.
  74. Merrett MN, Mortensen N, Kettlewell M, Jewell DO. Smoking may prevent pouchitis in patients with restorative proctocolectomy for ulcerative colitis. Gut 1996; 38:362.
  75. Hashavia E, Dotan I, Rabau M, et al. Risk factors for chronic pouchitis after ileal pouch-anal anastomosis: a prospective cohort study. Colorectal Dis 2012; 14:1365.
  76. de Silva HJ, de Angelis CP, Soper N, et al. Clinical and functional outcome after restorative proctocolectomy. Br J Surg 1991; 78:1039.
  77. Schmidt CM, Lazenby AJ, Hendrickson RJ, Sitzmann JV. Preoperative terminal ileal and colonic resection histopathology predicts risk of pouchitis in patients after ileoanal pull-through procedure. Ann Surg 1998; 227:654.
  78. White E, Melmed GY, Vasiliauskas EA, et al. A prospective analysis of clinical variables, serologic factors, and outcome of ileal pouch-anal anastomosis in patients with backwash ileitis. Dis Colon Rectum 2010; 53:987.
  79. Hata K, Watanabe T, Shinozaki M, Nagawa H. Patients with extraintestinal manifestations have a higher risk of developing pouchitis in ulcerative colitis: multivariate analysis. Scand J Gastroenterol 2003; 38:1055.
  80. Lepistö A, Kärkkäinen P, Järvinen HJ. Prevalence of primary sclerosing cholangitis in ulcerative colitis patients undergoing proctocolectomy and ileal pouch-anal anastomosis. Inflamm Bowel Dis 2008; 14:775.
  81. Seril DN, Yao Q, Lashner BA, Shen B. Autoimmune features are associated with chronic antibiotic-refractory pouchitis. Inflamm Bowel Dis 2015; 21:110.
  82. Seril DN, Yao Q, Shen B. Auto-inflammatory diseases in ileal pouch patients with NOD2/CARD15 mutations. Gastroenterol Rep (Oxf) 2016; 4:73.
  83. Fleshner P, Ippoliti A, Dubinsky M, et al. A prospective multivariate analysis of clinical factors associated with pouchitis after ileal pouch-anal anastomosis. Clin Gastroenterol Hepatol 2007; 5:952.
  84. Shen B, Fazio VW, Remzi FH, et al. Effect of withdrawal of nonsteroidal anti-inflammatory drug use on ileal pouch disorders. Dig Dis Sci 2007; 52:3321.
  85. Wu XR, Ashburn J, Remzi FH, et al. Male Gender Is Associated with a High Risk for Chronic Antibiotic-Refractory Pouchitis and Ileal Pouch Anastomotic Sinus. J Gastrointest Surg 2016; 20:631.
  86. Wu XR, Kirat HT, Xhaja X, et al. The impact of mesenteric tension on pouch outcome and quality of life in patients undergoing restorative proctocolectomy. Colorectal Dis 2014; 16:986.
  87. Mukewar S, Wu X, Lopez R, Shen B. Comparison of long-term outcomes of S and J pouches and continent ileostomies in ulcerative colitis patients with restorative proctocolectomy-experience in subspecialty pouch center. J Crohns Colitis 2014; 8:1227.
  88. Shen B, Plesec TP, Remer E, et al. Asymmetric endoscopic inflammation of the ileal pouch: a sign of ischemic pouchitis? Inflamm Bowel Dis 2010; 16:836.
  89. Banasiewicz T, Marciniak R, Kaczmarek E, et al. The diameter of the ileal J-pouch-anal anastomosis as an important risk factor of pouchitis - clinical observations. Med Sci Monit 2011; 17:CR91.
  90. Shen B, Remzi FH, Nutter B, et al. Association between immune-associated disorders and adverse outcomes of ileal pouch-anal anastomosis. Am J Gastroenterol 2009; 104:655.
  91. Navaneethan U, Venkatesh PG, Kapoor S, et al. Elevated serum IgG4 is associated with chronic antibiotic-refractory pouchitis. J Gastrointest Surg 2011; 15:1556.
  92. Fleshner P, Ippoliti A, Dubinsky M, et al. Both preoperative perinuclear antineutrophil cytoplasmic antibody and anti-CBir1 expression in ulcerative colitis patients influence pouchitis development after ileal pouch-anal anastomosis. Clin Gastroenterol Hepatol 2008; 6:561.
  93. Fleshner PR, Vasiliauskas EA, Kam LY, et al. High level perinuclear antineutrophil cytoplasmic antibody (pANCA) in ulcerative colitis patients before colectomy predicts the development of chronic pouchitis after ileal pouch-anal anastomosis. Gut 2001; 49:671.
  94. Kuisma J, Järvinen H, Kahri A, Färkkilä M. Factors associated with disease activity of pouchitis after surgery for ulcerative colitis. Scand J Gastroenterol 2004; 39:544.
  95. Singh S, Sharma PK, Loftus EV Jr, Pardi DS. Meta-analysis: serological markers and the risk of acute and chronic pouchitis. Aliment Pharmacol Ther 2013; 37:867.
  96. Okon A, Dubinsky M, Vasiliauskas EA, et al. Elevated platelet count before ileal pouch-anal anastomosis for ulcerative colitis is associated with the development of chronic pouchitis. Am Surg 2005; 71:821.
  97. Shen B, Achkar JP, Lashner BA, et al. Endoscopic and histologic evaluation together with symptom assessment are required to diagnose pouchitis. Gastroenterology 2001; 121:261.
  98. M'Koma AE, Wise PE, Schwartz DA, et al. Prevalence and outcome of anemia after restorative proctocolectomy: a clinical literature review. Dis Colon Rectum 2009; 52:726.
  99. Miller HL, Farraye FA, Coukos J, et al. Vitamin D deficiency and insufficiency are common in ulcerative colitis patients after ileal pouch-anal anastomosis. Inflamm Bowel Dis 2013; 19:E25.
  100. Khanna R, Wu X, Shen B. Low levels of vitamin D are common in patients with ileal pouches irrespective of pouch inflammation. J Crohns Colitis 2013; 7:525.
  101. Parsi MA, Shen B, Achkar JP, et al. Fecal lactoferrin for diagnosis of symptomatic patients with ileal pouch-anal anastomosis. Gastroenterology 2004; 126:1280.
  102. Lim M, Gonsalves S, Thekkinkattil D, et al. The assessment of a rapid noninvasive immunochromatographic assay test for fecal lactoferrin in patients with suspected inflammation of the ileal pouch. Dis Colon Rectum 2008; 51:96.
  103. Parsi MA, Ellis JJ, Lashner BA. Cost-effectiveness of quantitative fecal lactoferrin assay for diagnosis of symptomatic patients with ileal pouch-anal anastomosis. J Clin Gastroenterol 2008; 42:799.
  104. Johnson MW, Maestranzi S, Duffy AM, et al. Faecal calprotectin: a noninvasive diagnostic tool and marker of severity in pouchitis. Eur J Gastroenterol Hepatol 2008; 20:174.
  105. Matalon S, Elad H, Brazowski E, et al. Serum alpha-1 antitrypsin: a noninvasive marker of pouchitis. Inflamm Bowel Dis 2015; 21:589.
  106. Yamamoto T, Shimoyama T, Bamba T, Matsumoto K. Consecutive Monitoring of Fecal Calprotectin and Lactoferrin for the Early Diagnosis and Prediction of Pouchitis after Restorative Proctocolectomy for Ulcerative Colitis. Am J Gastroenterol 2015; 110:881.
  107. Farkas K, Bálint A, Bor R, et al. Faecal matrix metalloprotease-9 is a more sensitive marker for diagnosing pouchitis than faecal calprotectin: results from a pilot study. Expert Rev Gastroenterol Hepatol 2015; 9:387.
  108. Tang L, Cai H, Moore L, Shen B. Evaluation of endoscopic and imaging modalities in the diagnosis of structural disorders of the ileal pouch. Inflamm Bowel Dis 2010; 16:1526.
  109. Moskowitz RL, Shepherd NA, Nicholls RJ. An assessment of inflammation in the reservoir after restorative proctocolectomy with ileoanal ileal reservoir. Int J Colorectal Dis 1986; 1:167.
  110. Elder K, Lopez R, Kiran RP, et al. Endoscopic features associated with ileal pouch failure. Inflamm Bowel Dis 2013; 19:1202.
  111. Yanai H, Ben-Shachar S, Baram L, et al. Gene expression alterations in ulcerative colitis patients after restorative proctocolectomy extend to the small bowel proximal to the pouch. Gut 2015; 64:756.
  112. Shepherd NA, Jass JR, Duval I, et al. Restorative proctocolectomy with ileal reservoir: pathological and histochemical study of mucosal biopsy specimens. J Clin Pathol 1987; 40:601.
  113. de Silva HJ, Millard PR, Kettlewell M, et al. Mucosal characteristics of pelvic ileal pouches. Gut 1991; 32:61.
  114. Kariv R, Plesec TP, Gaffney K, et al. Pyloric gland metaplasia and pouchitis in patients with ileal pouch-anal anastomoses. Aliment Pharmacol Ther 2010; 31:862.
  115. Jiang W, Goldblum JR, Lopez R, et al. Increased crypt apoptosis is a feature of autoimmune-associated chronic antibiotic refractory pouchitis. Dis Colon Rectum 2012; 55:549.
  116. Ben-Bassat O, Tyler AD, Xu W, et al. Ileal pouch symptoms do not correlate with inflammation of the pouch. Clin Gastroenterol Hepatol 2014; 12:831.
  117. Navaneethan U, Venkatesh PG, Manilich E, et al. Prevalence and clinical implications of positive serum anti-microsomal antibodies in symptomatic patients with ileal pouches. J Gastrointest Surg 2011; 15:1577.
  118. Machiels K, Sabino J, Vandermosten L, et al. Specific members of the predominant gut microbiota predict pouchitis following colectomy and IPAA in UC. Gut 2017; 66:79.
  119. Werner L, Sturm A, Roggenbuck D, et al. Antibodies against glycoprotein 2 are novel markers of intestinal inflammation in patients with an ileal pouch. J Crohns Colitis 2013; 7:e522.
  120. Sahi KS, Lee KS, Moss A, et al. MR Enterography of the Ileoanal Pouch: Descriptive Radiologic Analysis With Endoscopic and Pathologic Correlation. AJR Am J Roentgenol 2015; 205:W478.
  121. Shen B, Remzi FH, Lavery IC, et al. A proposed classification of ileal pouch disorders and associated complications after restorative proctocolectomy. Clin Gastroenterol Hepatol 2008; 6:145.
  122. Wu B, Lian L, Li Y, et al. Clinical course of cuffitis in ulcerative colitis patients with restorative proctocolectomy and ileal pouch-anal anastomoses. Inflamm Bowel Dis 2013; 19:404.
  123. Shen B, Sanmiguel C, Bennett AE, et al. Irritable pouch syndrome is characterized by visceral hypersensitivity. Inflamm Bowel Dis 2011; 17:994.
  124. Shen B, Liu W, Remzi FH, et al. Enterochromaffin cell hyperplasia in irritable pouch syndrome. Am J Gastroenterol 2008; 103:2293.
  125. Hurst RD, Molinari M, Chung TP, et al. Prospective study of the incidence, timing and treatment of pouchitis in 104 consecutive patients after restorative proctocolectomy. Arch Surg 1996; 131:497.
  126. Okita Y, Araki T, Tanaka K, et al. Characteristics of extremely early-onset pouchitis after proctocolectomy with ileal pouch-anal anastomosis. J Gastrointest Surg 2013; 17:533.
  127. Mowschenson PM, Critchlow JF, Peppercorn MA. Ileoanal pouch operation: long-term outcome with or without diverting ileostomy. Arch Surg 2000; 135:463.
  128. Hurst RD, Chung TP, Rubin M, Michelassi F. The implications of acute pouchitis on the long-term functional results after restorative proctocolectomy. Inflamm Bowel Dis 1998; 4:280.
  129. Madiba TE, Bartolo DC. Pouchitis following restorative proctocolectomy for ulcerative colitis: incidence and therapeutic outcome. J R Coll Surg Edinb 2001; 46:334.
  130. Nicholls RJ. Review article: ulcerative colitis--surgical indications and treatment. Aliment Pharmacol Ther 2002; 16 Suppl 4:25.
  131. Liu ZX, Kiran RP, Bennett AE, et al. Diagnosis and management of dysplasia and cancer of the ileal pouch in patients with underlying inflammatory bowel disease. Cancer 2011; 117:3081.
  132. Kariv R, Remzi FH, Lian L, et al. Preoperative colorectal neoplasia increases risk for pouch neoplasia in patients with restorative proctocolectomy. Gastroenterology 2010; 139:806.
  133. Derikx LA, Kievit W, Drenth JP, et al. Prior colorectal neoplasia is associated with increased risk of ileoanal pouch neoplasia in patients with inflammatory bowel disease. Gastroenterology 2014; 146:119.