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Acute pouchitis — ESEGH MCQ

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ModerateInflammatory Bowel DiseaseAcute pouchitisESEGH

A 32-year-old man develops increased stool frequency and urgency 8 months after restorative proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis. Pouchoscopy shows diffuse pouch erythema and friability, with no cuffitis or Crohn's-like fistula. Stool cultures are negative. What is the most appropriate management?

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Correct answer: E — Ciprofloxacin or metronidazole

Acute pouchitis typically presents with increased frequency, urgency and pouch inflammation, and first-line treatment is usually antibiotics such as ciprofloxacin or metronidazole. Mesalazine is not the usual first-line treatment for acute pouchitis. Methotrexate and pancreatic enzymes do not target the diagnosis. The teaching point is that pouch symptoms need pouchoscopy to distinguish pouchitis, cuffitis and Crohn's-like disease.

Reference: BSG IBD Guideline 2025; ECCO Pouchitis Guidance