The cause of pouchitis is uncertain, though various theories exist. There are two ways to prevent or delay it that *sometimes* work: substantial doses of bacterial probiotics (VSL #3, now called Visbiome, is the one that’s been properly tested), and very-low carbohydrate diets. All carbohydrates are the same for this purpose, so starches, fruit, sugar, etc. are all equivalent carbs, and all need to be reduced for this diet. Calling some carbs “healthy” doesn’t change the fact that they are carbs. It’s a tough diet, I think, and it doesn’t work for everyone.
Cipro and/or Flagyl are the most common first-line pouchitis meds. Some doctors use Xifaxan/rifaximin, but I think it probably doesn’t work as well. When one doesn’t work or causes bad side effects another one may be effective and well-tolerated.
”Smoldering” can mean different things to different people. I intended it to mean a relatively mild case of pouchitis that causes some nighttime leakage or awakening, but doesn’t get worse than that. If it causes no symptoms at all but some inflammation can be seen on pouchoscopy I’d tend to call that “subclinical pouchitis.” There’s nothing inaccurate about calling such a case “smoldering,” but it makes two very different situations sound the same.