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These results show that this probiotic preparation is able to colonize the intestine, and suggest that it may be useful in maintaining the remission in ulcerative colitis patients intolerant or allergic to 5-ASA. Controlled trials are warranted to confirm these preliminary results.

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Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is a well-established surgical procedure for the management of ulcerative colitis and familial adenomatous polyposis. 1,2 Pouchitis, a non speci®c in¯ammation of the ileal reservoir, is the most frequent long-term complication following pouch surgery for ulcerative colitis. 3 Its cumulative frequency varies between 7 and 50% depending on the duration of follow-up and de®nition of pouchitis used. 4±6 This syndrome is characterized clinically by the presence of diarrhoea, rectal bleeding, faecal urgency, abdominal cramping, malaise and fever, endoscopically by oedema, granularity, mucus exudate and ulcerations, and histologically by neutrophil in®ltration, crypt abscesses and ulcerations in addition to chronic in¯ammatory in®l-trate. 7,8 Its exact cause(s) are poorly understood and pathogenetic theories abound, including faecal stasis with SUMMARY Background: Pouchitis is the major long-term complication after ileal pouch-anal anastomosis for ulcerative colitis. About 15% of patients have a chronic, treatment-resistant disease. Aims: To evaluate the ef®cacy of an antibiotic combination for chronic active, treatment-resistant pouchitis. Patients and Methods: Eighteen patients were treated orally with rifaximin 1 g b.d. + cipro¯oxacin 500 mg b.d. for 15 days. Symptoms assessment, endoscopic and histological evaluations were performed at screening and after 15 days using the Pouchitis Disease Activity Index (PDAI). Improvement was de®ned as a decrease of at least 3 points in PDAI score, and remission as a PDAI score of 0. Systemic absorption of rifaximin was determined by high performance liquid chromatography. Faecal samples were collected before and after antibiotic treatment for stool culture.

Results of this study indicate that treatment with mesalazine suppositories produces earlier and significantly better results than oral mesalazine in the treatment of active ulcerative proctitis.

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Bacteria are present throughout the gastrointestinal tract, but their pattern and concentration vary greatly. Probiotics are living organisms that supply beneficial health effects to the host. So far the beneficial effects of probiotics have been shown, almost exclusively, under poorly defined experimental conditions. There are little convincing data from well‐designed, double‐blind controlled trials supporting health‐promoting effects. The use of probiotics to treat gastrointestinal infections has produced contrasting results. Apart from information on rotavirus infection in children, there is no convincing evidence from controlled studies on the efficacy of probiotics in the prevention or treatment of infective diarrhoea. However, experimental and clinical studies suggest that there are potential therapeutic roles for probiotics in the treatment of inflammatory bowel diseases. This review focuses on the available data concerning the mechanisms of action of probiotics, and on the results from clinical studies using probiotics to treat infective diarrhoea and inflammatory bowel disease.