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Dysplasia of the ileal pouch mucosa after restorativeproctocolectomy is seen very rarely. There is a lack of data about its origin, diagnostic recommendations and therapeutic standards.Patients with ulcerative colitis having a restorativeproctocolectomy between 1984 and 2009 were followed. Inflammation and neoplasia were evaluated. The incidence of pouch excision or diverting ileostomy was also recorded.Inflammation was diagnosed in 66 (23.9%) patients, low grade dysplasia in 5 (1.8%) and high grade dysplasia in 3 (1.1%). One (0.4%) patient developed a malignant neoplasm. Low grade dysplasia was significantly more frequent in patients with inflammation than in those without. High grade dysplasia was seen significantly more often in patients with pouchitis. Logistic regression analysis shown that occurrence of pouch mucosal inflammation increases the risk of low grade dysplasia.Patients with chronic pouchitis, which increases risk of dysplasia, require regular surveillance of the pouch. The frequency of assessment should be done lonce per year. In patients without any gastrointestinal tract complaints, including of pouchitis, screening should be started 5 years after restorativeproctocolectomy.