Restorative proctocolectomy with ileal pouch–anal anastomosis
(IPAA) has become the surgical treatment of choice for
patients with medically refractory ulcerative colitis (UC), UC
with dysplasia, or for a majority of patients with familial
adenomatous polyposis (FAP).1–3 However, inflammatory
complications such as pouchitis, Crohn’s disease (CD) of
the pouch, and cuffitis often occur. Chronic pouchitis and CD
of the pouch are the two leading long-term causes for pouch
failure, resulting in permanent diversion or pouch excision.
While a variety of risk factors for these adverse pouch
outcomes have been studied,4 the value of histology of upper
gastrointestinal (GI) tract in diagnosis and differential
diagnosis of pouch disorders has not been systemically
investigated