title: Pharmacotherapy for acute pouchitis.
abstract: 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.
authors.affiliation: Iowa Inflammatory Bowel Disease Center, Des Moines, IA, USA. geoff.wall@drake.edu
authors.forename: Geoffrey C
authors.initials: GC
authors.lastname: Wall
authors.forename: Lori L
authors.initials: LL
authors.lastname: Schirmer
authors.forename: Lynn E
authors.initials: LE
authors.lastname: Anliker
authors.forename: Ashley E
authors.initials: AE
authors.lastname: Tigges
mesh_terms: D000208:Acute Disease; D000890:Anti-Infective Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D002908:Chronic Disease; D039021:Colonic Pouches / Q000009:adverse effects*; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000601:surgery*; D019449:Pouchitis / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D019936:Probiotics / Q000627:therapeutic use; D055502:Secondary Prevention; D013997:Time Factors
chemical_list: D000890:Anti-Infective Agents; D000893:Anti-Inflammatory Agents