Title:Prevention and Medical Treatment of Pouchitis In Ulcerative Colitis
Volume: 20
Issue: 13
Author(s): Cigdem Benlice, Bo Shen and Scott R. Steele*
Affiliation:
- Desk A-30, Department of Colorectal Surgery, Digestive Disease Institute Cleveland Clinic, 9500 Euclid Ave. Cleveland, OH 44195,United States
Keywords:
Pouchitis, prevention, probiotics, antibiotics, remission, medical therapy.
Abstract: Approximately 50% of patients who have undergone IPAA surgery for Ulcerative Colitis
(UC) develop at least 1 episode of pouchitis. Patients with pouchitis have a wide range of symptoms,
endoscopic and histologic features, disease course, and prognosis. To date, there are no universally accepted
diagnostic criteria in terms of endoscopy and histology; though, semi-objective assessments to
diagnose pouchitis in patients with ileal pouch- anal anastomosis (IPAA) have been proposed using
composite scores such as the Pouchitis Triad, Heidelberg Pouchitis Activity Score and Pouchitis Disease
Activity Index (PDAI). In a systematic review that included four randomized trials evaluating
five agents for the treatment of acute pouchitis, ciprofloxacin was more effective at inducing remission
as compared with metronidazole. Rifaximin was not more effective than placebo, while budesonide
enemas and metronidazole were similarly effective for inducing remission of acute pouchitis. Patients
with pouchitis relapsing more than three times per year are advised maintenance therapy, and
guidelines recommend ciprofloxacin or the probiotic VSL#3. In patients with antibiotic-refractory
pouchitis, secondary factors associated with an antibiotic-refractory course should be sought and
treated. In this review, we will discuss the prevention and management of pouchitis in Ulcerative Colitis
patients.
