Diagnosis and treatment of patients with pouchitis.
Pouchitis is the most common long-term complication of ileal pouch-anal anastomosis in patients with underlying ulcerative colitis. Clinical symptoms of pouchitis are not specific, and they can be caused by other conditions such as rectal cuff inflammation and irritable pouch syndrome. Therefore, to make an accurate diagnosis, endoscopic evaluation together with symptom assessment is necessary. Among five available treat-first and test-first strategies, the initial approach with pouch endoscopy without histology was the most cost-effective strategy for the diagnosis of pouchitis. On the basis of clinical course, pouchitis can be classified into acute, relapsing and chronic forms. Pouchitis can also be classified into three categories based on the response to antibacterial therapy: antibacterial-responsive; antibacterial-dependent; and antibacterial-resistant. Metronidazole and ciprofloxacin are both effective in treating acute pouchitis. Although antibacterial therapy can induce and maintain remission, probiotics such as VSL#3 can also be used as to maintain clinical remission and prevent relapse in patients with relapsing or chronic pouchitis. For patients with chronic pouchitis that is resistant to antibacterials, therapy with anti-inflammatory agents and immunomodulators is often required.
Shen
Bo
B
Department of Gastroenterology, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA. shenb@ccf.org
D000208:Acute Disease; D000276:Adjuvants, Immunologic / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D002908:Chronic Disease; D004334:Drug Administration Schedule; D016099:Endoscopy, Gastrointestinal; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D019449:Pouchitis / Q000145:classification / Q000175:diagnosis* / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic
D000276:Adjuvants, Immunologic; D000890:Anti-Infective Agents; D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents