Medical treatment of pouchitis: a guide for the clinician

Abstract

Pouchitis is the most common complication in patients who have undergone restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA). Up to 81% of IPAA patients experience pouchitis, with 40% of patients presenting within the first year of surgery. Common risk factors include genetic mutations, extensive colitis, rheumatologic disorders, and primary sclerosing cholangitis. Currently, there are no medications with approved indications for pouchitis. As such, the conventional treatment of pouchitis is entirely off-label. This paper is intended to be a practical and up-to-date review of available therapies used for the management of pouchitis. The mainstay of treatment for acute pouchitis remains antibiotics, but newer therapeutics have also shown promise in the treatment of chronic pouchitis. Common lifestyle considerations that may play a role in pouchitis are also reviewed. Plain language summary Medical treatment of pouchitis: a guide for the clinician The ileal pouch-anal anastomosis (“pouch”) is the most common way patients who require surgery to remove their colon are able to avoid a permanent ileostomy (“ostomy”). This pouch, created from the small intestines, serves as a reservoir to hold stool. The most common complication after pouch surgery is pouchitis. Pouchitis symptoms include more frequent bowel movements, urgency to defecate, blood in the stool, incontinence, and abdominal pain. This paper is intended to be a practical review of available therapies including medications and lifestyle changes that can be considered for the management of acute pouchitis, chronic pouchitis, and cuffitis.

Advantages of total proctocolectomy with straight ileoanal anastomosis plus pedicled omental transposition for familial adenomatous polyposis: a preliminary study

“…Compared to straight anastomosis, the technical requirements for pouch anastomosis are higher, but there is a risk of secondary intestinal resection due to pouch failure intraoperatively [ 24 , 25 ]. Pouchitis is one of the most common postoperative long-term complications, which seriously affects quality of life and may even result in the requirement of a second surgery [ 26 ].…”

Guidelines for the management of ulcerative colitis. Recommendations of the Polish Society of Gastroenterology and the Polish National Consultant in Gastroenterology

“…In the case of antibiotic intolerance, other treatment options may be considered (probiotics, and especially a probiotic product containing 8 well-studied strains – originally De Simone Formulation , budesonide, mesalazine) [ 114 , 119 ].…”

Ileo-Anal Pouch Anastomosis and New Remedial Approaches for Ulcerative Colitis: A Review Article

“…The overall pro-inflammatory characteristics of UC are most likely responsible for the frequency of pouchitis that occurs after IPAA for UC [ 18 ]. Common symptoms of pouchitis include increased bowel movements, watery stools, stomach pains, tenesmus, incontinence, and pelvic pressure [ 19 ]. Treatments for pouchitis are antibiotics (drugs for bacterial infections), budesonide enemas, probiotics (beneficial bacteria), biologicals that target tumor necrosis factor, butyrate suppositories, glutamine suppositories, bismuth enemas (diarrhea medicine), allopurinol and tinidazole [ 20 ].…”