Pre-pouch ileitis

We appreciate the comments of Dr. Bell et al.1 about the results of our study.2 Their findings are different from ours in terms of the presence or absence of pouchitis: half of their patients with pre-pouch ileitis had no pouchitis and most of them were asymptomatic,3 while all our patients with lesions in the ileum had a chronic refractory pouchitis. We investigated our patients to exclude a possible infectious aetiology without any positive results, indeed microbiological studies did not reveal significant differences in the pouch flora compared to controls. However, we found that 45.7% of patients with chronic refractory pouchitis had a positive association with allele TLR9-1237C and CD 14-260T.4 These data suggest that the alleles TLR9-1237C and CD14-260T enhance synergistically the risk of developing chronic relapsing pouchitis. We agree with Bell et al. about the need for routine evaluation of the ileum in all patients with ileal pouch-anal anastomosis. We have started to study the small bowel with wireless capsule endoscopy before colectomy, and after ileal pouch-anal anastomosis but before ileostomy closure.