(A) Refractory pouchitis with a PDAI of 10, (B) pouch with normal mucosa and PDAI of 4 in week 20 after VDZ; (C) histological aspect of chronic refractory pouchitis, (D) histological aspect of uninflamed pouch mucosa after therapy. (A) Refractory pouchitis with a PDAI of 10, (B) pouch with normal mucosa and PDAI of 4 in week 20 after VDZ; (C) histological aspect of chronic refractory pouchitis, (D) histological aspect of uninflamed pouch mucosa after therapy. PDAI, Pouchitis Disease Activity Index; VDZ, vedolizumab. Johannes Bethge et al. BMJ Open Gastroenterol 2017;4:e000127 Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/