title: Pouchitis: prevention and treatment.
abstract: OBJECTIVE
  Pouchitis, representing a spectrum of disease phenotypes, is the most common long-term complication in patients who have undergone restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA). Its management and prevention are challenging.
  
  
  RESULTS
  Treatment modalities vary according to phenotypes of pouchitis. The medical therapy of pouchitis remains largely empiric and antibiotic-based. However, patients may develop de-novo chronic antibiotic-refractory pouchitis (CARP) or progress from acute antibiotic-responsive phenotype. Patients with CARP often require alternative medical approaches to routine antibiotics, including the use of oral or topical mesalazine, corticosteroids, and sometimes immunomodulators or biological agents against tumour necrosis factor. There are two strategies to prevent pouchitis, the primary (i.e., the prevention of the initial episode) and secondary (i.e., the prevention of recurrent episodes) prophylaxis. There are scant data in the literature on nutritional aspects.
  
  
  CONCLUSIONS
  We evaluated the efficacy of current strategies of prevention and treatments of pouchitis and propose algorithms, including attention to nutrition wherein data exist.
authors.affiliation: aDepartment of Gastroenterology, Affiliated Hospital of Nantong University, Jiangsu, China bDepartment of Gastroenterology/Hepatology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA cDepartment of General Surgery, Qidong City Hospital, Jiangsu, China.
authors.forename: Zhaoxiu
authors.initials: Z
authors.lastname: Liu
authors.forename: Hui
authors.initials: H
authors.lastname: Song
authors.forename: Bo
authors.initials: B
authors.lastname: Shen
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D019449:Pouchitis / Q000188:drug therapy* / Q000517:prevention & control; D019936:Probiotics / Q000627:therapeutic use*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D007155:Immunologic Factors; D014409:Tumor Necrosis Factor-alpha