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“In addition to gut microbiota and mucosal immunity, genetic, vascular, and luminal factors (such as nonsteroidal anti-inflammatory drugs [NSAIDs]) are likely to contribute to the initiation, exacerbation, and progression of pouchitis. Pouchitis almost exclusively occurs in patients with restorative proctocolectomy with underlying IBD and rarely in those with FAP, suggesting the contribution of genetic and/systemic factors to its pathogenesis. Immunogenetic studies showed that genetic polymorphisms such as those of IL-1–receptor antagonist, 56 nucleotide-binding oligomerization domain containing 2/caspase recruitment domain family, member 15 (NOD2/CARD15), 5758 or a combined carriership of Toll-like receptor 9-1237C and CD14-260T alleles, 59 were associated with the risk for chronic pouchitis. Mutations of NOD2/CARD15 and TNFSF15 also were shown to be related to severe pouchitis.”

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