Pharmacotherapy for acute pouchitis.

OBJECTIVE

To review the current literature concerning the medical treatment of acute and chronic pouchitis.

METHODS

MEDLINE and International Pharmaceutical Abstracts were searched (both 1965-February 2011) using the following terms: pouchitis, Crohn's, ulcerative colitis, diagnosis, prophylaxis, and treatment. Bibliographies from key articles were also searched, and all pertinent articles were reviewed.

METHODS

All available primary literature published in English on treatment for pouchitis was considered, with controlled trials receiving highest priority.

RESULTS

Pouchitis occurs in up to 50% of ileal pouch-anal anastomosis (IPAA) patients with inflammatory bowel disease within 10 years of the procedure. Symptoms include abdominal pain, bloating, and fecal incontinence with frequent diarrhea. The diagnosis of pouchitis is usually made based on symptoms as well as endoscopic and histologic findings. Treatment of acute pouchitis includes antimicrobials such as ciprofloxacin, metronidazole, and rifaximin. If these fail, limited data suggest that oral budesonide, mesalamine, or infliximab may be effective treatments. Surgical revision may be necessary if medical treatments fail. Emerging evidence suggests that the probiotic compound VSL#3 may be effective in preventing the recurrence of pouchitis.

CONCLUSIONS

Pouchitis is a common complication of IPAA surgery. The strongest data suggest that antimicrobial therapy is an effective first-line treatment for acute pouchitis, and VSL#3 may be effective for prevention of recurrence.