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Review
. 2020 Apr;8(3):256-262.
doi: 10.1177/2050640619900571. Epub 2020 Jan 13.

Pouchitis: Treatment dilemmas at different stages of the disease

Manuel Barreiro-de Acosta  1 , Iria Bastón-Rey  1 , Cristina Calviño-Suárez  1 , J Enrique Domínguez-Muñoz  1
Affiliations
Review

Pouchitis: Treatment dilemmas at different stages of the disease

Manuel Barreiro-de Acosta et al. United European Gastroenterol J. 2020 Apr.

Abstract

Pouchitis is a frequent complication in ulcerative colitis patients after proctocolectomy with ileal pouch-anal anastomosis. It is an unspecific inflammation of the pouch with unknown aetiology. First-line treatment for acute and chronic pouchitis is antibiotics. Some cases of severe chronic refractory pouchitis may benefit from biological treatment. Anti-tumour necrosis factor should be recommended as the first option, leaving the new biologicals for multirefractory patients. Permanent ileostomy may be an option in severe cases, after failure of medical treatment. Prophylaxis therapy with a probiotic mixture is recommended after the first episode of pouchitis, whereas it is not clear whether probiotics are useful for all patients after surgery. Here, we present a case report and review the treatment options in different forms of pouchitis.

Keywords: Ulcerative colitis; anti-TNF; antibiotics; pouchitis; probiotics.

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Figures

Figure 1.
Figure 1.
Endoscopic image of pouchitis.
Figure 2.
Figure 2.
Treatment algorithm for pouchitis.
See this image and copyright information in PMC

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