@Pouchomarx posted:fyi, pouch inflammation will almost always show up on pouch biopsies.. My former GI the great Dr Shen said he only treats pouchitis on visual scope or symptoms, and never on just biopsy reports..
So Shen essentially said biopsy/histology is very sensitive but not as specific for pouchitis. Interesting. I read an earlier paper of his detailing a proposed scoring system for pouchitis which included symptoms, gross pouch appearance and histology. There was a certain point threshold one had to meet but essentially you need contribution of 2 out of 3 domains to get there (maybe 3/3, my memory sucks). He made the point that too many are treated based on symptoms alone, with unnecessary exposure to abx. I was treated empirically for pouchitis, felt better, then had a scope after 10+ days on cipro that was normal. Wonder if I ever had it to begin with or if inflammation had healed by then. Guess I’ll never know but I will push for a scope before taking abx again.