title: Diagnosis and treatment of pouchitis.
abstract: Total proctocolectomy with ileal pouch-anal anastomosis is the surgical procedure of choice for the management of ulcerative colitis. Pouchitis, a non-specific inflammation of the ileal reservoir, is the most frequent complication that patients experience in the long-term. Diagnosis should be made on the basis of clinical, endoscopic and histological aspects. The Pouchitis Disease Activity Index (PDAI) represents an objective and reproducible scoring system for pouchitis: active pouchitis is defined as a score > or = 7 and remission as a score < 7. About 15% of patients develop a chronic disease. Treatment of pouchitis is empirical, and very few controlled studies have been carried out. Antibiotics, particularly metronidazole and ciprofloxacin, are the treatment of choice. Chronic pouchitis may benefit from a prolonged course of a combination of antibiotics. Highly concentrated probiotics are effective for both prevention of relapses and prevention of pouchitis onset. There is no convincing evidence of the efficacy of other therapeutic agents.
authors.affiliation: University of Bologna, Department of Internal Medicine and Gastroenterology, Policlinico S Orsola, Via Massarenti no 9, 40138 Bologna, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Gionchetti
authors.forename: Cristina
authors.initials: C
authors.lastname: Amadini
authors.forename: Fernando
authors.initials: F
authors.lastname: Rizzello
authors.forename: Alessandro
authors.initials: A
authors.lastname: Venturi
authors.forename: Gilberto
authors.initials: G
authors.lastname: Poggioli
authors.forename: Massimo
authors.initials: M
authors.lastname: Campieri
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003093:Colitis, Ulcerative / Q000628:therapy; D003937:Diagnosis, Differential; D016145:Endoscopy, Digestive System; D006801:Humans; D019449:Pouchitis / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D019936:Probiotics / Q000627:therapeutic use; D016737:Proctocolectomy, Restorative / Q000009:adverse effects
chemical_list: D000900:Anti-Bacterial Agents