Editor,—Mr Phillips (Gut1998;43:303–4) enjoys stirring the pot, but we cannot support all of his views on ileo-anal pouch surgery for Crohn’s disease. Firstly, we do not think ulcerative colitis and Crohn’s disease are necessarily “apples and oranges” (though familial adenomatous polyposis is). We believe that there is often a spectrum of disease and that in some cases only the long term natural history enables clinicians to know whether they are dealing with one or other disorder.

Also, we do not think it is appropriate to compare the outcome of Kock pouch surgery against pelvic pouch surgery for Crohn’s disease. If there is a stricture in or above a pouch which is out of the pelvis, the chances of successful reconstruction without pouch excision is much greater than for pouches in the pelvis (as our own experience confirms).

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