How is pouchitis diagnosed?

The doctor will consider the patient’s symptoms and the results of an endoscopy (examination of the inside of the pouch with an instrument called an endoscope). A pouchoscopy (endoscopy of the pouch) can show how widespread the inflammation is, whether or not the ileum is irritated, or if the patient has Crohn’s disease or Crohn’s-like disease of the pouch.

Endoscopy can also show if the patient has cuffitis (inflammation at the anal transition zone, or cuff), or abnormalities such as narrowed passages or cavities or openings. Patients who have cuffitis often have bright red blood (mild to moderate, or on wiping) in stool.

The doctor may take a biopsy (sample of the tissue) during the endoscopy to look for other unusual things, such as polyps, infection, any inflamed granulated (grainy) tissue, or a restricted blood supply.

Imaging studies such as contrast pouchography, CT (computed tomography), gastrografin enema, barium defecography, and/or MRI (magnetic resonance imaging) of the pelvis or abdomen may also be used to help with diagnosis. A test called anorectal manometry is helpful in learning if the pelvic floor is not functioning properly, especially in patients who strain during defecation.

Last reviewed by a Cleveland Clinic medical professional on 01/16/2019.

References

  • Shen B, Lashner BA. Diagnosis and Treatment of Pouchitis. Gastroenterol Hepatol (N Y) May 2008;4(5): 355–361.
  • Shen B. Pouchitis: What Every Gastroenterologist Needs to Know. Clinical Gastroenterology and Hepatology, December 2013 Volume 11, Issue 12, Pages 1538–1549. DOI: https://doi.org/10.1016/j.cgh.2013.03.033
  • Achkar J-P, Al-Haddad M, Lashner B, et al. Differentiating Risk Factors for Acute and Chronic Pouchitis. Clinical Gastroenterology and Hepatology 2005;3:60–66.
  • Gionchetti P, Calafiore A, Riso D, et al. The role of antibiotics and probiotics in pouchitis. Ann Gastroenterol. 2012; 25(2): 100–105.

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy