Chronic pouchitis: what every gastroenterologist needs to know

Background Chronic pouchitis is a complication after restorative proctocolectomy with ileal pouch-anal anastomosis in ulcerative colitis (UC) and patients with familial adenomatous polyposis. Despite medical advances, many patients develop chronic inflammation in the ileal pouch, affecting their quality of life. Objective This narrative review provides an overview of chronic pouchitis, focusing on pathogenesis, clinical presentation, diagnostics and management, highlighting the need for a multidisciplinary approach. Methods A comprehensive literature review was conducted, analysing studies on chronic pouchitis incidence, pathogenesis, diagnosis and treatment, with an emphasis on emerging therapies and personalised medicine. Results The pathogenesis of chronic pouchitis involves genetic, immunological, microbial and environmental factors. Symptoms include increased stool frequency, urgency and abdominal pain. Diagnosis relies on clinical evaluation, endoscopy and histology. Management includes antibiotics, probiotics, immunomodulators, biologics and dietary interventions. Emerging therapies like anti-TNFα monoclonal antibodies, vedolizumab, ustekinumab and small molecules show promise for refractory cases. Conclusion Effective chronic pouchitis management requires a personalised approach. Treatment aims to alleviate symptoms and prevent recurrence. Chronic pouchitis can severely impact on a patient’s quality of life, and therefore surgical options remain a valuable alternative for those not responding to medical therapy. Ongoing research and interdisciplinary collaboration are essential to improve patient outcomes.