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Background: With an increasing number of patients with inflammatory and non-inflammatory complications of the ileal pouch, in 2002 CCF Digestive Disease Institute established a subspecialty Pouchitis Clinic for diagnosis and management of pouch-associated disorders. A cursory review of our referral pattern revealed that pouchitis may be misdiagnosed and mistreated. Aim: To identify patient groups and reasons for misdiagnosis.Methods: A historical cohort of 245 patients from the Pouchitis Clinic were included. The clinical variables evaluated included: age, sex, age at onset of disease, year of IPAA, reason for the operation, comorbidities such as diabetes, steroid use, smoking, NSAID use, pre-referral diagnosis, pre-referral treatment regimen, endoscopic findings, pathological results, post-referral diagnosis and post-referral treatment regimen.Results: Of the 245 patients (51% were females, median age 50 years, 87% with a preoperative diagnosis of ulcerative colitis, 3% CD, 4% FAP, 0.5% indeterminate, 5% other) with presumed pouchitis and other pouch disorders, 117 (48%) had the diagnosis revised to most commonly irriable pouch syndrome (IPS) or Crohn’s disease (CD) of the pouch. Of the 101 patients referred from outside hospitals, 57 (56%) had a revision of diagnosis. 136 patients had diagnosis of pouchitis before referral, and 69 patients had diagnosis of pouchitis post-referral. IPS was diagnosed in 22 patients pre-referral, and 123 post-referral.Conclusion: Our findings suggest that it is important to use clinical, endoscopic and histological assessment to establish accurate diagnosis. The subspecialty care would optimize patients’ care Future Topics : Recognition of IPS; accurate diagnostic and treatment algorithm for pouchitis, cost benefit analysis of management of pouch related disorders in a tertiary center.
Preoperative diagnosis

Preop Diagnosis	n(%)
UC	214(87%)
Crohn's colitis	8(3%)
FAP	9(4%)
indeterminate colitis	1(0.5%)
other	13(5%)

Revision in diagnosis

Diagnosis	pre-referral(%)	post-referral(%)
pouchitis	136 (56%)	69 (28%)
fistula/sinus/stricture		22(9%)
CD	10(4%)	25(10%)
pouch dysfunction/diarrhea	54(22%)
IPS	22(9%)	123(50%)
Small bowel bacterial overgrowth	2(1%)	31(13%)

24 pts had double dx (IPS+SBBO, or CD+fistula/stricture)