NYAG,
I think my J Pouch inlet stricture is definitely a wear and tear situation over 30 years, both because of the backsplash stool and because an MRI Enterography back in 2012 documented inflammation and narrowing at the inlet that we have been watching ever since. In 2017 or so my GI warned me if it ever closed up to the point of not getting a scope through the inlet I would have to be dilated, and then in 2021 he finally couldn't get a scope through. So this was not an overnight development. We first observed and documented narrowing of the inlet in 2012 and in the 9 years since it slowly closed up. So it is my belief that it is at least in my case a wear and tear and mechanical issue from backsplash stool.
Is this what awaits everyone with a J Pouch after 30 years of hard driving on the J Pouch? Probably not. But we have seen on this board a number of long term pouches strictured at the inlet after many years. In many or most of those cases the inflammation is probably coming from back splashing and pooling stool at or above the inlet. Nothing can be done about it except to dilate and hope for a result like Sadie. You can't stop the back splashing because there is no backsplash valve on J pouches like there is in the colon.