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The Association Between Autoimmunity and Pouchitis

Seril, Darren N. MD, PhD*; Yao, Qingping MD, PhD; Shen, Bo MD*

doi: 10.1097/01.MIB.0000435761.82705.6a
Basic Review Articles

Abstract: Restorative proctocolectomy with ileal pouch-anal anastomosis is commonly used in the management of ulcerative colitis. Inflammation of the ileal pouch reservoir, or pouchitis, is a common complication of ileal pouch-anal anastomosis that is incompletely understood. Risk factors including nonsmoker status and primary sclerosing cholangitis have been linked with pouchitis development, but the etiopathogenesis of pouchitis remains poorly defined. Pouchitis is more commonly a complication of ileal pouch-anal anastomosis performed in patients with ulcerative colitis, and similar to ulcerative colitis, chronic pouchitis is associated with extraintestinal manifestations and other diseases of immune origin, suggesting overlap in the disease pathogenesis. It is becoming apparent that pouchitis encompasses clinically distinct subtypes based on the response or lack of response to antibiotic therapy. There is also emerging evidence of the role of autoimmunity in a subgroup of patients with pouchitis, including patients with concurrent primary sclerosing cholangitis, seropositivity for immunoglobulin G4, or infiltration of immunoglobulin G4–expressing plasma cells in the pouch mucosa. The identification of underlying autoimmunity may have important clinical implications in the diagnosis, subclassification, and management of pouchitis.

Article first published online 26 December 2013

Departments of *Gastroenterology/Hepatology, and

Rheumatic and Immunologic Disease, The Cleveland Clinic Foundation, Cleveland, Ohio.

Reprints: Bo Shen, MD, Department of Gastroenterology/Hepatology-A31, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195 (e-mail:

The authors have no conflicts of interest to disclose.

Received August 26, 2013

Accepted September 17, 2013

© Crohn's & Colitis Foundation of America, Inc.
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