# Recurrent Pouchitis Uncovering De Novo Celiac Disease

## TL;DR

A woman with a history of ulcerative colitis developed chronic pouchitis after surgery, which was later found to be caused by newly diagnosed celiac disease.

## Contribution

This case highlights celiac disease as a potential underlying cause of chronic refractory pouchitis.

## Key findings

- Chronic antibiotic-refractory pouchitis resolved after a gluten-free diet was initiated.
- De novo celiac disease was confirmed through antibody testing, endoscopy, and histopathology.
- Symptoms did not recur during a 9-month follow-up period on a gluten-free diet.

## Abstract

We present the case of a 39-year-old woman with a history of severe ulcerative colitis (UC) that was refractory to 5-aminosalicylates, corticosteroids, and biologics, and who subsequently underwent total colectomy with ileal pouch–anal anastomosis (IPAA). She developed chronic antibiotic-refractory pouchitis (CARP) characterized by recurrent abdominal pain, cramping, and diarrhea unresponsive to standard treatments. A comprehensive workup, including testing for anti-tissue transglutaminase IgA antibodies, led to the diagnosis of de novo celiac disease, confirmed by endoscopic and histopathologic findings. Initiation of a gluten-free diet resulted in the resolution of symptoms, with no relapse observed during a 9-month follow-up. Our case highlights the importance of considering secondary etiologies such as celiac disease in patients with chronic refractory pouchitis and emphasizes the need for tailored management strategies.