Oral budesonide in the treatment of chronic refractory pouchitis.
BACKGROUND
Pouchitis is the major long-term complication after ileal-pouch nal anastomosis for ulcerative colitis. Ten to 15% of patients develop a chronic pouchitis, either treatment responsive or treatment refractory.


OBJECTIVE
To evaluate the efficacy of oral budesonide in inducing remission and improving quality of life in patients with chronic refractory pouchitis.


METHODS
Twenty consecutive patients with active pouchitis, not responding after 1 month of antibiotic treatment were treated with budesonide controlled ileal release 9 mg/day for 8 weeks. Symptomatic, endoscopic and histological evaluations were undertaken before and after treatment according to Pouchitis Disease Activity Index. Remission was defined as a combination of Pouchitis Disease Activity Index clinical score of < or = 2, endoscopic score of < or = 1 and total Pouchitis Disease Activity Index score of < or = 4. The quality of life was assessed with the Inflammatory Bowel Disease Questionnaire.


RESULTS
Fifteen of 20 patients (75%) achieved remission. The median total Pouchitis Disease Activity Index scores before and after therapy were, respectively, 14 (range 9-16) and 3 (range 2-10) (P < 0.001). The median Inflammatory Bowel Disease Questionnaire score also significantly improved from 105 (range 77-175) to 180 (range 85-220) (P < 0.001).


CONCLUSIONS
Eight-week treatment with oral budesonide appears effective in inducing remission in patients with active pouchitis refractory to antibiotic treatment in this open-label study.
Gionchetti
P
P
Department of Internal Medicine and Gastroenterology, University of Bologna, Bologna, Italy. paolo@med.unibo.it
Rizzello
F
F
Poggioli
G
G
Pierangeli
F
F
Laureti
S
S
Morselli
C
C
Tambasco
R
R
Calabrese
C
C
Campieri
M
M
D000284:Administration, Oral; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D019819:Budesonide / Q000008:administration & dosage*; D002908:Chronic Disease; D003093:Colitis, Ulcerative / Q000601:surgery; D003692:Delayed-Action Preparations; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D019449:Pouchitis / Q000188:drug therapy*; D011788:Quality of Life / Q000523:psychology*; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D003692:Delayed-Action Preparations; D019819:Budesonide