Bacteriology in the etiopathogenesis of pouchitis.
BACKGROUND
Pouchitis is the most common long-term complication in ulcerative colitis that follows restorative proctocolectomy. Clinical evidence suggests that dysbiosis plays a key role in its pathogenesis.


METHODS
Current literature on the topic was reviewed. A therapeutic approach was proposed based on the literature along with personal experience from the subspecialty Pouchitis Clinic.


RESULTS
Pouchitis represents a disease spectrum in the reservoir, with ranging etiopathogenesis, clinical phenotypes, disease courses and prognoses. Dysbiosis plays a critical role in disease initiation and progress, with antibiotic therapy as the mainstay for treatment. On the other hand, superimposed infection from pathogens contributes to flare-up of the disease. Pouchitis can progress into an 'IBD-like' condition, requiring anti-inflammatory, immunomodulator or even biological therapy.


CONCLUSIONS
Pouchitis represents a unique form of IBD. Investigation on the evolution from an antibiotic-responsive phenotype to chronic antibiotic-refractory pouchitis may shed some light on the pathogenesis and therapeutic targets of IBD.
Digestive Disease Institute, the Cleveland Clinic Foundation, Cleveland, Ohio, USA. shenb@ccf.org
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D000818:Animals; D001419:Bacteria / Q000378:metabolism*; D006801:Humans; D015994:Incidence; D019449:Pouchitis / Q000453:epidemiology / Q000382:microbiology*; D015995:Prevalence