IPS

IPS is diagnosed by process of elimination. Your rule out other causes of pouchitis symptoms, and you are left with IPS. It basically means pouchitis symptoms without inflammation. But SIBO can cause pouchitis symptoms too, without inflammation. The difference is that antibiotics work for SIBO.

Jan

So if you have inflammation than you don't have IPS or SIBO. It's pouchitis then correct?

Yes and no. You can have both pouchitis and IPS. So, it is complicated. But, if you do not have inflammation and do not respond to antibiotics, it is likely IPS.

Jan

I was diagnosed with IPS before I had pouchitis.  I had IBS with UC so it makes since. I think I still have it with my pouchitis.  I read a paper written my Dr. Shen and others on this before I had pouchitis.  I was being treated with antibiotics which didn't make sense to me.  The paper basically said it's a newer diagnosis that is basically like what Jan's saying.

A substantial number of patients symptomatic after IPAA do not meet the diagnostic criteria for pouchitis. Therefore, we designed a study to assess the etiology in this group of patients. We described a unique subgroup of patients with IPAA who present with pouch symptoms but have normal endoscopic and histologic findings. We considered this subgroup to have irritable pouch syndrome (IPS), which is indicated by a PDAI of <7 and the absence of cuffitis. The etiology of symptoms in IPS is not clear, and there is no algorithm for its management. Nearly 50% of patients with IPS respond symptomatically to regimens typically used in irritable bowel syndrome, including reassurance, dietary modification, dietary fiber supplementation, antidiarrheal, antispasmodic, and antidepressant therapy.³⁹

This is deep into the paper linked below:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2780072/

It's a good paper for us all to read as it covers not only IPS but the other pouch problems we might have.