Pilot study: the use of sulfasalazine for the treatment of acute pouchitis.
BACKGROUND
Acute pouchitis, an idiopathic inflammatory condition of the ileal pouch anal anastomosis, is the most frequent complication after proctocolectomy for ulcerative colitis.


OBJECTIVE
To test the hypothesis that sulfasalazine (SASP) might have a synergistic beneficial effect in acute pouchitis, by combining the anti-inflammatory activity of 5-aminosalicylic Acid and the bacteriostatic effect of sulphapyridine.


METHODS
Twenty two patients were investigated for acute pouchitis; the Pouchitis Disease Activity Index (PDAI) was calculated and 11 patients with acute pouchitis (PDAI >7) were included in an open study, after obtaining their informed consent. Patients were treated with SASP 500 mg tablets, two tablets three times per day (3000 mg daily), for 2 months. Pouch endoscopy with biopsies was performed at the entry and at the end of the study.


RESULTS
According to the PDAI score, 8/11 patients (73%) improved their clinical condition and 7/11 (63%) were in remission at the end of the treatment. At 8 weeks, the median PDAI index decreased from 11.2 +/- 2.3 to 6.6 +/- 4.7 P < 0.01. No adverse events or toxicity were reported and all patients completed the study.


CONCLUSIONS
Despite the limitations of the current study, sulfasalazine seems to be a potential treatment for acute pouchitis.
Belluzzi
A
A
Department of Gastroenterology and Internal Medicine, Gastroenterology Unit S'Orsola Hospital, University of Bologna, Italy. andrea.belluzzi@aosp.bo.it
Serrani
M
M
Roda
G
G
Bianchi
M L
ML
Castellani
L
L
Grazia
M
M
Rosati
G
G
Ugolini
G
G
Roda
E
E
D000328:Adult; D039021:Colonic Pouches / Q000473:pathology*; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology*; D008297:Male; D019804:Mesalamine / Q000627:therapeutic use*; D008875:Middle Aged; D010865:Pilot Projects; D019449:Pouchitis / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D016737:Proctocolectomy, Restorative / Q000009:adverse effects*; D012720:Severity of Illness Index; D012460:Sulfasalazine / Q000627:therapeutic use*; D016896:Treatment Outcome; D055815:Young Adult
D012460:Sulfasalazine; D019804:Mesalamine