Pouchitis — RACP Adult Medicine MCQ

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ModerateGastroenterology & HepatologyPouchitisRACP Adult Medicine

A 40-year-old man with ulcerative colitis undergoes total proctocolectomy with ileal pouch-anal anastomosis (IPAA). 12 months later, he develops bloody diarrhoea, urgency, and pouch inflammation on endoscopy. What is the most likely complication?

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Correct answer: D — Pouchitis

Pouchitis is the most common complication after IPAA for UC, occurring in up to 50% of patients. It presents with increased stool frequency, bloody diarrhoea, urgency, and cramping. Diagnosis is confirmed by pouchoscopy showing mucosal inflammation and biopsies excluding other causes. First-line treatment is oral metronidazole 400 mg TDS or ciprofloxacin 500 mg BD for 14 days. Chronic/relapsing pouchitis may require long-term antibiotics, probiotics (VSL#3), budesonide, or biologics (vedolizumab, infliximab). Crohn's disease should be excluded in refractory cases.

Reference: eTG – 2025 – Gastrointestinal; ECCO – 2022 – Pouchitis Guidelines