Pouchitis: Epidemiology, clinical manifestations, and diagnosis. Accessed Sept. Brown AY. AllScripts EPSi. Mayo Clinic. Mayo Clinic Press Check out these best-sellers and special offers on books and newsletters from Mayo Clinic. Some people with ulcerative colitis have their colon and rectum removed with construction of a pouch made from a loop of small intestine in place of the rectum - known as ileal pouch-anal anastomosis IPAA surgery.
Pouchitis is inflammation of the surgically-constructed pouch. Symptoms of active pouchitis include diarrhea, increased stool frequency, abdominal cramping, fecal urgency, tenesmus feeling of constantly needing to pass stools , and incontinence.
Acute refers to symptoms that last less than four weeks while chronic refers to symptoms that last more than four weeks.
Periods when symptoms stop are called 'remission'. Therapies used for pouchitis include antibiotics drugs for bacteria infections , budesonide enemas a steroid drug , probiotics helpful bacteria , biologic agents that target tumor necrosis factor, glutamine suppositories an amino acid , butyrate suppositories short chain fatty acid , bismuth enemas diarrhea medication , allopurinol a purine analogue drug , and tinidazole an anti-parasitic drug. The researchers investigated whether these medications produce remission in people with active pouchitis, maintain remission in people with inactive pouchitis or prevent pouchitis in people who've had IPAA surgery.
Side effects were also assessed. The medical literature was searched up to 25 July We found 15 studies with a total of participants. Four studies assessed treatment of acute pouchitis. Five studies assessed treatment of chronic pouchitis.
Six studies assessed prevention of pouchitis. Acute pouchitis: It is uncertain whether ciprofloxacin is more effective than metronidazole for treatment of acute pouchitis 1 study, 16 participants. Peripheral neuropathy can occur with long-term use and may be irreversible. Patients on maintenance antibiotics who lose response may respond to rotating antibiotics in 1 to 3 week intervals eg, 3 weeks of metronidazole, followed by 3 weeks of ciprofloxacin, and then 3 weeks of rifaximin.
With concerns about the chronic use of systemically absorbed antibiotics in patients with chronic pouchitis, alternative approaches to management should be considered.
Non-absorbable antibiotics such as rifaximin may play a role, but they have only been studied adequately in a controlled fashion as combination therapy with ciprofloxacin in patients with chronic refractory pouchitis. Probiotics have received much attention as a means of altering the pouch flora and maintaining remission in chronic pouchitis.
Patients are first treated with an antibiotic course to induce remission, and then the probiotic combination is added and administered chronically after the antibiotic course is completed.
I will try this approach in patients with chronic pouchitis who are willing to take a daily probiotic supplement. My practice is to give 1 packet of VSL 3 tid, or a twice-daily dosing of an alternative probiotic that contains multiple strains of probiotic organisms. In patients who clearly have continued active pouchitis, budesonide may play a role in treating active inflammation. Two mg budesonide enemas have demonstrated efficacy in clinical trials, but are not readily available in the United States.
These patients will require attention to bone health with calcium and vitamin D supplementation, as well as with monitoring bone density. Topical therapy with mesalamine has not been found to be routinely effective in the treatment of acute or chronic pouchitis.
However, since the alternative of removing the pouch and creating an end ileostomy is not acceptable to many patients, I have used these agents with some success.
The dosing is the same as what would be used to treat CD—1 to 1. Overall, pouchitis is a common and often frustrating disease entity to treat. Accurate diagnosis and initial treatment with antibiotics should be undertaken. For patients with chronic pouchitis, long-term low-dose antibiotics or antibiotics followed by probiotics should be considered.
Some people need to have their large bowel colon removed by surgery. This is usually because they have a condition called ulcerative colitis that causes inflammation and ulcers in the large bowel, or because they have another disease in the large bowel, such as cancer.
After removing the large bowel, it may be possible for the surgeon to make a 'pouch' out of the last part of the small bowel to connect it to the anus or back passage so that people can still pass stools in the normal way.
This pouch acts as a 'reservoir' to collect stools before the person is ready to pass them in the normal way through a bowel movement.
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