PT - JOURNAL ARTICLE AU - A Hillary Steinhart AU - Ofer Ben-Bassat TI - Pouchitis: a practical guide AID - 10.1136/flgastro-2012-100171 DP - 2013 Jul 01 TA - Frontline Gastroenterology PG - 198--204 VI - 4 IP - 3 4099 - http://fg.bmj.com/content/4/3/198.short 4100 - http://fg.bmj.com/content/4/3/198.full SO - Frontline Gastroenterol2013 Jul 01; 4 AB - Up to 30% of patients with ulcerative colitis (UC) will require surgical management. The established surgical procedure of choice is colectomy with ileal pouch–anal anastomosis (IPAA) for most patients. Patients with UC who have undergone IPAA are prone to develop inflammatory and non-inflammatory complications. Up to 50% of patients can be expected to experience at least one episode of pouchitis, and most of these patients will experience at least one additional acute episode within 2 years. In other cases, pouchitis might follow a relapsing-remitting course or a chronically active course. The specific aetiology of pouchitis is unknown and the optimal means of diagnosis and classification of pouchitis is not completely agreed upon. Diagnosis of pouchitis based on symptoms alone has been shown to be non-specific due to the fact that symptoms can originate from a myriad of aetiologies, not necessarily inflammatory in nature. As a result, the diagnosis of pouchitis should generally be based on the appropriate constellation of symptoms, combined with endoscopic and histological assessment. Due to the frequently relapsing course of pouchitis, and the fact that the aetiology and pathogenesis are not entirely clear, the long-term management can sometimes be challenging. This review outlines the features suggestive of deviation from ‘normal’ pouch function and provides an approach to the optimal use of diagnostic modalities and medical therapies to treat pouchitis in its various forms.