Which condition pattern is most commonly considered for IPAA eligibility?

• A. Chronic ulcerative colitis limited to the colon
• B. Crohn's disease affecting the small intestine
• C. Irritable bowel syndrome with no structural disease
• D. Diverticular disease with extensive sigmoid involvement

Answer: (A)

The key idea is that IPAA is usually considered when the inflammatory disease is chronic ulcerative colitis confined to the colon. UC affects the colon in a continuous way, which makes the disease pattern predictable and the surgical approach of removing the colon and creating an ileal pouch to connect to the anus feasible and durable. When Crohn’s disease involves the small intestine (or has significant perianal or transmural involvement), the risk that disease will affect the pouch is higher, leading to pouchitis or pouch failure, so IPAA is less favorable. Functional disorders like irritable bowel syndrome have no structural disease to justify colectomy with a pouch, and diverticular disease with extensive sigmoid involvement isn’t the classic UC-like pattern that makes IPAA appropriate. Therefore, the most common match for IPAA eligibility is chronic ulcerative colitis limited to the colon.