GI Endoscopy · 1 min read
Endoscopic Grading of the Ileal Pouch (PDAI)
Pouchitis is a common complication after surgery for ulcerative colitis. Learn about its symptoms, causes, and effective treatment options to manage this condition.
Clinical Bottom Line
| Assessment Dimension | Pouchitis Disease Activity Index (PDAI) Component | Scoring Criteria |
|---|---|---|
| Clinical Symptoms | Stool frequency, urgency, gross bleeding, and fever. | 0 to 6 points. |
| Endoscopic Findings | Edema, granularity, friability, loss of vascular pattern, mucus exudate, ulceration. | 0 to 6 points (Objective mucosal scoring). |
| Histological Acute Inflammation | Polymorphonuclear leukocyte infiltration; ulceration depth per High Power Field. | 0 to 6 points. |
Surveilling the Surgically Reconstructed Bowel
For patients with medically refractory Ulcerative Colitis or Familial Adenomatous Polyposis (FAP) who underwent a total proctocolectomy, the surgical creation of an Ileal Pouch-Anal Anastomosis (IPAA, or J-Pouch) restores continence. While the diseased colon is gone, the terminal ileum (now acting as a pseudo-rectum) frequently undergoes severe, recurrent inflammation known as Pouchitis.
The PDAI Framework
Diagnosing Pouchitis cannot rely on symptoms alone, as increased stool frequency (4-6 times per day) is the normal baseline for a functional J-Pouch. The Pouchitis Disease Activity Index (PDAI) is the universally mandated 18-point rubric. A true diagnosis requires a total score ≥ 7. The endoscopist's role is strictly to score the middle third of the index via Pouchoscopy—visually identifying intense friability and deep mucosal ulcerations exclusively within the pouch reservoir—and to secure the histological biopsies required to confirm acute neutrophilic infiltration, definitively separating true inflammatory Pouchitis from mechanical ischemic strictures or occult Crohn's disease of the pouch.
Clinical guidelines summarized by the Gastroscholar Research Team. Last updated: 2026. This article is intended for physicians.
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