Materiały źródłowe

• #1 Medical treatment of pouchitis: a guide for the clinician

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8239975/

  Pouchitis is the most common complication in patients who have undergone restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA). […] Currently, there are no medications with approved indications for pouchitis. As such, the conventional treatment of pouchitis is entirely off-label. This paper is intended to be a practical and up-to-date review of available therapies used for the management of pouchitis. The mainstay of treatment for acute pouchitis remains antibiotics, but newer therapeutics have also shown promise in the treatment of chronic pouchitis. […] Probiotics have been studied for use in pouchitis as primary or secondary prophylaxis. […] First-line therapy for acute pouchitis includes ciprofloxacin 500mg BID or metronidazole 500mg TID for 24weeks. […] Antibiotics are the first-line treatment for pouchitis. A majority of patients with pouchitis will require treatment with antibiotics episodically.

• #1 Pouchitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pouchitis/diagnosis-treatment/drc-20574832

  Antibiotics are the most common treatment for pouchitis. Most people improve within 1 to 2 days of starting antibiotics and do not develop pouchitis again. The full course of treatment is usually 10 to 14 days, although longer courses are sometimes needed. […] Someone who has regular flare-ups of pouchitis may need ongoing maintenance antibiotic therapy. Using probiotics may help prevent pouchitis from coming back. […] On rare occasions, pouchitis doesn’t respond to daily treatment. Then surgeons may need to remove the pouch and do a permanent ileostomy.

• #1

  https://www.wjgnet.com/1007-9327/full/v13/i42/5598.htm

  For antibiotic-responsive pouchitis, the first-line therapy includes a 14-d course of oral metronidazole (15-20 mg/kg per day) or ciprofloxacin (1000 mg/d). A randomized trial of ciprofloxacin and metronidazole showed that patients treated with ciprofloxacin experience significantly greater reductions in the PDAI scores and fewer adverse effects than those treated with metronidazole. Other agents have been reported in open-labeled trials including tetracycline, clarithromycin, amoxicillin/clavulanic acid, doxycycline, rifaximin, and budesonide enemas, alicaforsen enemas, an anti-sense inhibitor of intercellular adhesion molecule-1, and AST-120, a highly adsorptive, porous, carbon microspheres. […] Patients with antibiotic-dependent pouchitis often require long-term maintenance therapy with either antibiotics or probiotics to keep disease in remission. A randomized trial of VSL#3 at a dose of 6 g/d was conducted for the secondary prophylaxis for relapse of pouchitis, after remission was induced by oral ciprofloxacin (1000 mg/d) and rifaximin (2000 mg/d). During the 9-mo trial in 40 patients with relapsing pouchitis, only 15% in the probiotic group relapsed while 100% in the placebo group relapsed.

• #1 A Review of the Diagnosis and Treatment of Inflammatory Pouch Conditions – Practical Gastro

  https://practicalgastro.com/2023/05/11/a-review-of-the-diagnosis-and-treatment-of-inflammatory-pouch-conditions/

  There are no approved medications for acute pouchitis, however, the mainstay of treatment is antibiotics. […] Patients with acute pouchitis who do not initially respond to a standard two week course may be treated with an additional two week course or may be transitioned to alternative antibiotics such as tinidazole, rifampin, or amoxicillin-clavulanate. […] The most commonly used antibiotics for CADP are ciprofloxacin and/or metronidazole. […] Rifaximin and probiotics (VSL#3) have also been shown to be effective in the management of CADP, though evidence is limited. […] CARP is defined as symptoms of pouchitis that fail to respond to a four-week course of antibiotics and require escalation of therapy to mesalamine, corticosteroids or biologics. […] Biologic agents such as infliximab, adalimumab, vedolizumab, and ustekinumab are commonly used for the management of CARP.

• #1 Pouchitis: What It Is, Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/15484-pouchitis

  Possible treatments include: Mesalamine enemas, Bismuth enemas, Corticosteroids, Immunosuppressants, Monoclonal antibodies (biologics), Small molecules, Fecal microbiota transplant. […] Symptoms of acute pouchitis usually improve within a few days of beginning antibiotic treatment. It’s important to complete the whole two-week course of antibiotics, though, even if you’re feeling better. […] Some evidence suggests that probiotics may help prevent pouchitis from occurring after surgery or from recurring after successful treatment.

• #1 Diagnosis and Treatment of Pouchitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3093723/

  Patients with antibiotic-dependent pouchitis often require long-term maintenance therapy with either antibiotics or probiotics for maintenance of disease remission. […] Antibiotic-refractory pouchitis is often difficult to treat and a common cause of pouch failure. […] Treatment options include a prolonged course of combined antibiotic therapy, 5-aminosalicylates, corticosteroids, immunosuppressive agents, or even biologic therapy. […] Management of antibiotic-dependent and antibiotic-refractory pouchitis remains a challenge.

• #1

  https://www.healio.com/news/gastroenterology/20201001/how-do-you-treat-pouchitis

  The most common antibiotic regimens used for chronic pouchitis are ciprofloxacin 250 to 500 mg/day and metronidazole 500 mg/day. […] Patients on maintenance antibiotics who lose response may respond to rotating antibiotics in 1 to 3 week intervals (eg, 3 weeks of metronidazole, followed by 3 weeks of ciprofloxacin, and then 3 weeks of rifaximin.) […] Probiotics have received much attention as a means of altering the pouch flora and maintaining remission in chronic pouchitis. […] Patients are first treated with an antibiotic course to induce remission, and then the probiotic combination is added and administered chronically after the antibiotic course is completed. […] If antibiotics or antibiotic/probiotic combinations are not successful in managing pouchitis symptoms, the diagnosis should again be questioned.

• #1 Diagnosis and Medical Treatment of Acute and Chronic Idiopathic Pouchitis in Inflammatory Bowel Disease

  https://www.mdpi.com/1648-9144/60/6/979

  Taking into consideration the limited data on other antibiotics, ciprofloxacin and metronidazole remain the preferred agents for the treatment of pouchitis with the most available evidence. […] In chronic antibiotic-dependent pouchitis, AGA recommends treatment with antibiotics with the lowest effective dose that can be used in an intermittent course, for example, one week per month or switching between ciprofloxacin, metronidazole and vancomycin every 1–2 weeks. […] Corticotherapy seems to be effective in inducing clinical remission in patients with antibiotic-refractory pouchitis, with budesonide-controlled ileal release being the preferred formulation. […] Vedolizumab seems effective in biologic-experienced patients with chronic pouchitis. […] Ustekinumab was studied on twenty-four patients with chronic pouchitis.

• #1 Chronic pouchitis: what every gastroenterologist needs to know | Frontline Gastroenterology

  https://fg.bmj.com/content/16/2/143

  Chronic pouchitis is treated initially with antibiotics with an efficacy of 70%-80% initially, and relapse in 15%-40%. […] For antibiotic refractory cases, biological therapies including infliximab (up to 88% efficacy), vedolizumab (30%-40% efficacy) and tofacitinib (50%-60% efficacy) can be useful, although more randomised data are necessary. […] Dietary therapies (including the Mediterranean and Crohns disease exclusion diets) and probiotics may also benefit select patients as preventative strategies. […] Surgical options may be considered with recurrent severe pouchitis, or when impacting significantly on a patients quality of life. […] The management of chronic pouchitis encompasses a multimodal approach tailored to individual patient characteristics and disease severity. […] Due to increasing evidence of the influence of dysbiosis on pouchitis development, various therapeutic interventions have emerged targeting microbiota modulation.

• #1 Management of pouchitis and inflammatory pouch disorders – American Gastroenterological AssociationAGA Logo_Horizontal

  https://gastro.org/clinical-guidance/management-of-pouchitis-and-inflammatory-pouch-disorders/

  In patients with ulcerative colitis who have undergone IPAA and experience recurrent episodes of pouchitis that respond to antibiotics, the AGA suggests using probiotics for preventing recurrent pouchitis. […] In patients with ulcerative colitis who have undergone IPAA, and experience recurrent pouchitis that responds to antibiotics but relapses shortly after stopping antibiotics (commonly referred to as chronic antibiotic-dependent pouchitis), the AGA suggests using chronic antibiotic therapy to treat recurrent pouchitis. […] In patients with ulcerative colitis who have undergone IPAA, and experience recurrent pouchitis which responds to antibiotics but relapses shortly after stopping antibiotics (commonly referred to as chronic antibiotic-dependent pouchitis), the AGA suggests using advanced immunosuppressive therapies to treat recurrent pouchitis.

• #1

  https://www.wjgnet.com/1007-9327/full/v13/i42/5598.htm

  Antibiotic-refractory pouchitis which is often difficult to treat, is a common cause of pouch failure. Since the patients typically do not respond to full-dose, single-agent antibiotic therapy, it is important to investigate contributing causes (in secondary pouchitis) related to failure to antibiotic therapy. Secondary causes of refractory disease include use of NSAID, concurrent Clostridium difficile or cytomegalovirus infection, celiac disease and other autoimmune disorders, cuffitis, CD of the pouch, pouch ischemia, and inflammatory polyps of the pouch. There are no randomized trials in the literature for this category of pouchitis. For patients without obvious causes, treatment options include a prolonged course of combined antibiotic therapy, 5-aminosalicylates, corticosteroids, immunosuppressive agents or even biological therapy. Regimens reported in open-labeled trials include combined ciprofloxacin (1000 mg/d) with rifaximin (2000 mg/d) or metronidazole (1000 mg/d) or tinidazole (1000-1500 mg/d) for 4 wk. However, maintenance of remission in this group of patients after the induction therapy with dual antibiotics remains a challenge. Anti-inflammatory agents, immunomodulators, and biological therapy have been used to treat pouchitis. These agents include bismuth carbomer enemas, short-chain fatty acid enemas, and glutamine enemas, mesalamine enemas, oral budesonide, 6-mercaptopurine, and infliximab.

• #1 Medical treatment of pouchitis: a guide for the clinician

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8239975/

  In chronic antibiotic refractory pouchitis, steroids have been used as a second-line treatment for pouchitis. […] The anti-tumor necrosis factor inhibitors (anti-TNFs) have shown moderate success in treating chronic refractory pouchitis and Crohns-like complications of the pouch. […] The mainstay of treatment for acute pouchitis remains antibiotics. However, for patients with chronic pouchitis who cannot take or are refractory to antibiotics, more traditional IBD treatments such as corticosteroids, biologics, small molecule drugs, and others can be considered.

• #1 Pouchitis: Clinical Features, Diagnosis, and Treatment | IJGM

  https://www.dovepress.com/pouchitis-clinical-features-diagnosis-and-treatment-peer-reviewed-fulltext-article-IJGM

  Treatment of CARP is challenging and this form of pouchitis is one of the most common causes of pouch failure. […] A combination of two antibiotics can be effective, such as ciprofloxacin (1 g per day) with either rifaximin (2 g per day) metronidazole (1 g per day) or tinidazole (11.5 g per day) for 4 weeks. […] Oral budesonide for 8 weeks determined 75% of remission; oral beclomethasone dipropionate and topical tacrolimus are effective alternatives. […] In case of failure in inducing remission, systemic corticosteroids, immunosuppressants and anti-TNF drugs including infliximab and adalimumab can be used.

• #1 Key Focus Areas in Pouchitis Therapeutic Status: A Narrative Review

  https://ijms.sums.ac.ir/article_50229.html

  Long-term safety and efficacy of maintenance antibiotic therapy for chronic pouchitis was assessed revealing remission in 21% of patients and side effects in 28% of patients. […] Ciprofloxacin was recommended as the first-line treatment for pouchitis. […] In case of severe chronic refractory pouchitis, patients may benefit from biological treatment of anti-tumor necrosis factor (TNF). […] Treatment with 9 mg budesonide for 8 weeks, as a corticosteroid medication, could improve the quality of life in 20 patients with antibiotic-refractory pouchitis with a remission rate of 75%. […] Vedolizumab, a monoclonal antibody, can selectively block gut lymphocyte trafficking by interacting with 47 heterodimer. […] Ustekinumab, as another treatment of choice for pouchitis, is a human IgG1 kappa monoclonal antibody against p40 subunit of interleukin-12/23.

• #1 Chronic pouchitis: what every gastroenterologist needs to know | Frontline Gastroenterology

  https://fg.bmj.com/content/16/2/143

  Bismuth, particularly carbomer enemas, has been found to provide significant clinical and histopathological improvement in patients with treatment-resistant pouchitis. […] Short-term tacrolimus therapy can also be a viable option for antibiotic-refractory pouchitis with few adverse effects, however one study has shown that patients often relapsed during tapering. […] Oral beclomethasone has also showed remarkable results when tested on refractory pouchitis; in one study, 8 (80%) out of 10 patients achieved remission within 8 weeks. […] Due to the role of the immune system in pouchitis pathophysiology, another option is to use immunomodulators like biologics (eg, anti-TNF agents) in treatment. […] Vedolizumab has been found to be a promising drug for managing chronic pouchitis. […] Ustekinumab has also been found to be efficacious in treating chronic pouchitis.

• #1 Diagnosis and Medical Treatment of Acute and Chronic Idiopathic Pouchitis in Inflammatory Bowel Disease

  https://www.mdpi.com/1648-9144/60/6/979

  Despite the decreased rates in inflammatory bowel disease (IBD) colectomies due to high advances in therapeutic options, a significant number of patients still require proctocolectomy with ileal pouch-anal anastomosis (IPPA) for ulcerative colitis (UC). […] Acute cases usually respond well to antibiotics, but 15% of patients will still develop a refractory disease that requires the initiation of advanced immunosuppressive therapies. For chronic idiopathic pouchitis, current recommendations suggest using the same therapeutic options as for IBD in terms of biologics and small molecules. […] Vedolizumab is the only biologic agent that has received approval for the treatment of adult patients with moderately to severely active chronic refractory pouchitis. […] The treatment of pouchitis is challenging. Usually, acute pouchitis has a favorable response to antibiotics, but up to 15% of patients develop a chronic phenotype, either antibiotic-dependent or antibiotic refractory, which needs the initiation of immunosuppressive treatments.

• #1 Vedolizumab first approved therapy for chronic pouchitis – Medical Conferences

  https://conferences.medicom-publishers.com/content/conference-reports/vedolizumab-first-approved-therapy-for-chronic-pouchitis-2/

  Vedolizumab showed clinical, endoscopic, and histologic benefits over placebo in participants with chronic pouchitis after ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC). […] The phase 4 EARNEST trial is the first and largest randomised-controlled trial to demonstrate significant benefits of a biologic therapy in patients with chronic pouchitis. […] Therefore, the double-blind, placebo-controlled EARNEST trial (NCT02790138) randomised participants with chronic pouchitis after proctocolectomy with IPAA for UC (n=102) 1:1 to vedolizumab (300 mg, intravenous, administered at day 1 and weeks 2, 6, 14, 22, and 30) or placebo. […] Vedolizumab outperformed placebo with respect to the primary endpoint (mPDAI remisson 31.4% vs 9.80%; P=0.013). […] In addition, mPDAI response rates favoured vedolizumab over placebo after 14 weeks (62.7% vs 33.3%; P=0.003) and 34 weeks (51.0% vs 29.4%; P=0.026).

• #1 Diagnosis and Medical Treatment of Acute and Chronic Idiopathic Pouchitis in Inflammatory Bowel Disease

  https://www.mdpi.com/1648-9144/60/6/979

  A retrospective single-center study identified eight patients treated with tofacitinib for chronic pouchitis. […] Pouchitis is the most common inflammatory complication in patients with UC who underwent total proctocolectomy with IPAA. Current treatment options include antibiotics in infrequent episodes and advanced immunosuppressive treatments in chronic disease.

• #1 Chronic pouchitis: what every gastroenterologist needs to know | Frontline Gastroenterology

  https://fg.bmj.com/content/16/2/143

  Janus kinase (JAK) inhibitors such as tofacitinib and upadacitinib are used in UC and CD, but previous research has shown little to no efficacy in treating chronic pouchitis. […] Several studies have investigated the use of probiotics in preventing the initial episode of pouchitis. […] Antibiotics such as tinidazole and sulfasalazine have also been found to show some success in preventing pouchitis. […] The overall prevalence of pouch failure in patients over 18 who have undergone restorative proctocolectomy for UC is 6%.

• #1

  https://www.healio.com/news/gastroenterology/20201001/how-do-you-treat-pouchitis

  In patients who continue to have refractory pouchitis, there are anecdotal reports of the efficacy of immunomodulators such as 6-mercaptopurine (6-MP)/azathioprine and infliximab. […] Overall, pouchitis is a common and often frustrating disease entity to treat. Accurate diagnosis and initial treatment with antibiotics should be undertaken. […] For patients with chronic pouchitis, long-term low-dose antibiotics or antibiotics followed by probiotics should be considered. […] In patients who continue to have problems, oral budesonide may control symptoms. […] In patients who continue to have refractory disease, immunosuppression or immunomodulation with 6-MP, azathioprine, or infliximab can be considered.

• #1 Treatment Options For Pouchitis – Klarity Health Library

  https://my.klarity.health/treatment-options-for-pouchitis/

  Management of pouchitis is similar to those of inflammatory bowel disease if a definite cause cannot be identified. […] Lastly, even in the absence of a Clostridioides difficile infection, fecal microbiota transplants may help to reestablish a healthy gut microbiome. […] Chronic antibiotic-resistant pouchitis, or CARP for short, is a condition in which antibiotic therapy does not resolve the pouchitis, or causes it to improve but only for the condition to reappear later. […] Bismuth enemas and mesalamine enemas, which help reduce symptoms and target pouch inflammation, respectively, may also be considered. […] Prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs) can also damage the lining of the pouch. […] While acute pouchitis complications are not very common, prolonged or untreated cases may cause problems.

• #1

  https://link.springer.com/article/10.1007/s11938-023-00438-w

  Pouchitis is common after restorative proctocolectomy and ileal pouch-anal anastomosis in patients with underlying ulcerative colitis. A majority of patients with acute antibiotic-responsive pouchitis develop chronic antibiotic-dependent pouchitis or antibiotic-refractory pouchitis. […] While acute pouchitis often responds to oral antibiotic therapy, chronic pouchitis usually requires induction and maintenance therapy. Biological agents, particularly vedolizumab, may be used for the treatment of chronic pouchitis. […] The treatment of chronic antibiotic-refractory pouchitis is similar to that of IBD, with confounding factors from surgery-associated ischemia and concurrent autoimmune disorders, particularly primary sclerosing cholangitis. […] Hyperbaric oxygen therapy showed promising effects on chronic pouchitis.

• #1 Management of pouchitis and inflammatory pouch disorders – American Gastroenterological AssociationAGA Logo_Horizontal

  https://gastro.org/clinical-guidance/management-of-pouchitis-and-inflammatory-pouch-disorders/

  In patients with ulcerative colitis who have undergone IPAA, and develop symptoms due to Crohn’s-like disease of the pouch, the AGA suggests using corticosteroids. […] In patients with ulcerative colitis who have undergone IPAA and develop symptoms due to Crohn’s-like disease of the pouch, the AGA suggests using advanced immunosuppressive therapies. […] In patients with ulcerative colitis who have undergone IPAA, and develop symptoms due to cuffitis, the AGA suggests using therapies that have been approved for the treatment of ulcerative colitis, including topical 5-aminosalicylates, topical corticosteroids, etc.

• #1 A Review of the Diagnosis and Treatment of Inflammatory Pouch Conditions – Practical Gastro

  https://practicalgastro.com/2023/05/11/a-review-of-the-diagnosis-and-treatment-of-inflammatory-pouch-conditions/

  There is currently insufficient evidence to recommend one biologic over another for CARP, however, it is important to consider a patients pre-colectomy biologic use. […] CDLPI is typically refractory to antibiotics and steroids, and biologics are firstline. […] The main stay treatment for cuffitis is topical mesalamine similar to proctitis. […] Although data are limited, the choice of therapy is directly related to the diagnosis and options range from antibiotics to biologics.

• #1 What Is Pouchitis and How Can It Be Prevented?

  https://www.everydayhealth.com/ibd/living-with-pouchitis/

  Research published in March 2023 in the New England Journal of Medicine found that the biologic Vedolizumab (Entyvio) was more effective than placebo at inducing remission in patients with chronic pouchitis. […] While there is no foolproof way to prevent pouchitis, Holubar says that, in general, a healthy lifestyle can help. […] Some research, such as trials described in a review published in May 2019 in the Cochrane Database of Systematic Reviews, suggests that probiotics can be beneficial in preventing relapses of pouchitis.

• #1 Novel GI-Selective Therapy Gets Orphan Drug Designation for Pouchitis – MPR

  https://www.empr.com/home/news/drugs-in-the-pipeline/novel-gi-selective-therapy-gets-orphan-drug-designation-for-pouchitis/

  The Food and Drug Administration (FDA) has granted Orphan Drug designation to AMT-101 for the treatment of pouchitis, an inflammation that develops following ileal pouch-anal anastomosis surgery in patients with ulcerative colitis. […] Following the results observed in our FILLMORE trial demonstrating compelling activity of AMT-101 in pouchitis, we look forward to continued collaboration with the FDA as we remain focused on phase 3 advancement in this patient population.

• #1 Stem Cells for the Treatment of Pouchitis

  https://ctv.veeva.com/study/stem-cells-for-the-treatment-of-pouchitis

  The purpose of this study is to determine the safety and feasibility of using allogeneic bone marrow derived mesenchymal stem cells (MSCs) to treat people with medically refractory Pouchitis. […] Given the high safety profile, and substantial success in treating perianal CD, the investigators are using a GMP grade allogeneic adipose derived MSCs to establish safety and secondarily monitor for healing in patients with medically refractory pouchitis. […] The specific rationale for MSCs in medical refractory pouchitis is based upon 1) their anti-inflammatory properties; 2) published experience of MSC in this condition and perianal Crohn’s fistula demonstrating efficacy and safety; 3) existence of cGMP methods for their isolation and growth. […] The study will enroll adult patients with medically refractory pouchitis, whose next option in the treatment plan would be major reconstructive abdominal surgery or pouch excision with a permanent end ileostomy.

• #1 Therapy for treatment and prevention of pouchitis | Cochrane

  https://www.cochrane.org/CD001176/IBD_therapy-treatment-and-prevention-pouchitis

  Therapies used for pouchitis include antibiotics (drugs for bacteria infections), budesonide enemas (a steroid drug), probiotics (helpful bacteria), biologic agents that target tumor necrosis factor, glutamine suppositories (an amino acid), butyrate suppositories (short chain fatty acid), bismuth enemas (diarrhea medication), allopurinol (a purine analogue drug), and tinidazole (an anti-parasitic drug). […] The effects of antibiotics, probiotics and other interventions for treating and preventing pouchitis are uncertain. More research is needed to determine which of these different medications are best for treatment of pouchitis. […] The effects of antibiotics, probiotics and other interventions for treating and preventing pouchitis are uncertain. Well designed, adequately powered studies are needed to determine the optimal therapy for the treatment and prevention of pouchitis.

• #1 Key Focus Areas in Pouchitis Therapeutic Status: A Narrative Review

  https://ijms.sums.ac.ir/article_50229.html

  The effectiveness and safety of tacrolimus as an immunosuppressive drug in a review of 188 patients with chronic refractory pouchitis were assessed showing a clinical remission of 57.1%. […] The safety and efficacy of Hange-Shashin-To (HST) as a combination of seven herbs in the treatment of chronic pouchitis was assessed in 14 patients revealing a decrease in the total ciprofloxacin dose in the absence of any adverse events. […] Pouchitis can develop in patients with IBD after IPAA and lead to a significant impairment in quality of life. As pouchitis treatment is still one of the biggest gaps of knowledge in IBD and efficacy of treatments for pouchitis are still uncertain, well-designed and adequately powered studies are needed to assess optimal treatments in the therapy and prevention of pouchitis.

• #2 Diagnosis and Treatment of Pouchitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3093723/

  Ileal pouch-anal anastomosis following total proctocolectomy has become part of the standard surgical treatment for patients with ulcerative colitis or familial adenomatous polyposis who require colectomy. […] Pouchitis is the most common long-term complication of ileal pouch surgery and has a significant adverse impact on patient quality of life. […] The management of pouchitis, particularly chronic antibiotic-refractory pouchitis, which is one of the leading causes of pouch failures, can be challenging. […] The majority of patients with pouchitis respond favorably to antibiotic therapy, particularly in the initial stages of disease, some patients develop pouchitis refractory to routine antibiotic treatment. […] For antibiotic-responsive pouchitis, first-line therapy includes a 14-day course of metronidazole (15-20 mg/kg/day) or ciprofloxacin (1,000 mg/day).

• #2 Medical treatment of pouchitis: a guide for the clinician

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8239975/

  Pouchitis is the most common complication in patients who have undergone restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA). […] Currently, there are no medications with approved indications for pouchitis. As such, the conventional treatment of pouchitis is entirely off-label. This paper is intended to be a practical and up-to-date review of available therapies used for the management of pouchitis. The mainstay of treatment for acute pouchitis remains antibiotics, but newer therapeutics have also shown promise in the treatment of chronic pouchitis. […] Probiotics have been studied for use in pouchitis as primary or secondary prophylaxis. […] First-line therapy for acute pouchitis includes ciprofloxacin 500mg BID or metronidazole 500mg TID for 24weeks. […] Antibiotics are the first-line treatment for pouchitis. A majority of patients with pouchitis will require treatment with antibiotics episodically.

• #2

  https://www.healio.com/news/gastroenterology/20201001/how-do-you-treat-pouchitis

  Total abdominal colectomy with ileal-pouch anal anastomosis (IPAA) has become the main surgical alternative for medically refractory ulcerative colitis (UC), UC with dysplasia, and familial adenomatous polyposis (FAP) over the past 2 decades. […] Patients typically present with an increased stool frequency, pelvic discomfort, urgency, and, occasionally, stool leakage and rectal bleeding. […] Approaches to the treatment of pouchitis have involved the manipulation of both the pouch microflora and the mucosal immune system. […] In a patient presenting with a first episode of acute pouchitis, antibiotics are the mainstay of therapy, although optimal treatment regimens remain to be defined. […] My practice is to start with a metronidazole 500 mg bid (twice a day) and, if not tolerated, then switch to a ciprofloxacin 500 mg bid.

• #2 Pouchitis: What It Is, Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/15484-pouchitis

  Pouchitis is inflammation in your ileal pouch. Treatment with antibiotics works in most cases. For most people, pouchitis is an acute, temporary condition, but for some people, it becomes a chronic condition. […] First-line treatment for acute pouchitis is a two-week course of antibiotics. This works for most people. If it doesn’t work for you, your provider will try a longer course with a different antibiotic, or a combination. […] If acute pouchitis goes away with treatment but then comes back, your provider will treat it again in the same way. The treatment is the same as long as it continues to work and you don’t have relapses too often. […] If your pouchitis never improved with antibiotics, or if it once did, but it no longer does, healthcare providers call this chronic antibiotic-resistant pouchitis (CARP).

• #2 A Review of the Diagnosis and Treatment of Inflammatory Pouch Conditions – Practical Gastro

  https://practicalgastro.com/2023/05/11/a-review-of-the-diagnosis-and-treatment-of-inflammatory-pouch-conditions/

  There are no approved medications for acute pouchitis, however, the mainstay of treatment is antibiotics. […] Patients with acute pouchitis who do not initially respond to a standard two week course may be treated with an additional two week course or may be transitioned to alternative antibiotics such as tinidazole, rifampin, or amoxicillin-clavulanate. […] The most commonly used antibiotics for CADP are ciprofloxacin and/or metronidazole. […] Rifaximin and probiotics (VSL#3) have also been shown to be effective in the management of CADP, though evidence is limited. […] CARP is defined as symptoms of pouchitis that fail to respond to a four-week course of antibiotics and require escalation of therapy to mesalamine, corticosteroids or biologics. […] Biologic agents such as infliximab, adalimumab, vedolizumab, and ustekinumab are commonly used for the management of CARP.

• #2 Pouchitis: Clinical Features, Diagnosis, and Treatment | IJGM

  https://www.dovepress.com/pouchitis-clinical-features-diagnosis-and-treatment-peer-reviewed-fulltext-article-IJGM

  The most important approach is the elimination of causing factor, such as NSAID use, eradication of infection, correction of mechanical complications. […] Oral vancomycin should be considered first line in the management of pouch CDI. […] Patients with concurrent inflammatory or mechanical conditions of the pouch, such as pouch outlet stricture, cuffitis and CD of the pouch, should be treated either with endoscopic dilation, or topical anti-inflammatory agents, immunomodulators and/or biological therapy. […] The probiotic preparation De Simone Formulation has been shown to prevent pouchitis onset within the first year after surgery in a randomised, double-blind, placebo-controlled study. […] Patients with antibiotic-responsive pouchitis could develop frequent relapses and require maintenance therapy.

• #2 Diagnosis and Treatment of Pouchitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3093723/

  Patients with antibiotic-dependent pouchitis often require long-term maintenance therapy with either antibiotics or probiotics for maintenance of disease remission. […] Antibiotic-refractory pouchitis is often difficult to treat and a common cause of pouch failure. […] Treatment options include a prolonged course of combined antibiotic therapy, 5-aminosalicylates, corticosteroids, immunosuppressive agents, or even biologic therapy. […] Management of antibiotic-dependent and antibiotic-refractory pouchitis remains a challenge.

• #2 Chronic pouchitis: what every gastroenterologist needs to know | Frontline Gastroenterology

  https://fg.bmj.com/content/16/2/143

  Bismuth, particularly carbomer enemas, has been found to provide significant clinical and histopathological improvement in patients with treatment-resistant pouchitis. […] Short-term tacrolimus therapy can also be a viable option for antibiotic-refractory pouchitis with few adverse effects, however one study has shown that patients often relapsed during tapering. […] Oral beclomethasone has also showed remarkable results when tested on refractory pouchitis; in one study, 8 (80%) out of 10 patients achieved remission within 8 weeks. […] Due to the role of the immune system in pouchitis pathophysiology, another option is to use immunomodulators like biologics (eg, anti-TNF agents) in treatment. […] Vedolizumab has been found to be a promising drug for managing chronic pouchitis. […] Ustekinumab has also been found to be efficacious in treating chronic pouchitis.

• #2 Vedolizumab first approved therapy for chronic pouchitis – Medical Conferences

  https://conferences.medicom-publishers.com/content/conference-reports/vedolizumab-first-approved-therapy-for-chronic-pouchitis-2/

  Vedolizumab showed clinical, endoscopic, and histologic benefits over placebo in participants with chronic pouchitis after ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC). […] The phase 4 EARNEST trial is the first and largest randomised-controlled trial to demonstrate significant benefits of a biologic therapy in patients with chronic pouchitis. […] Therefore, the double-blind, placebo-controlled EARNEST trial (NCT02790138) randomised participants with chronic pouchitis after proctocolectomy with IPAA for UC (n=102) 1:1 to vedolizumab (300 mg, intravenous, administered at day 1 and weeks 2, 6, 14, 22, and 30) or placebo. […] Vedolizumab outperformed placebo with respect to the primary endpoint (mPDAI remisson 31.4% vs 9.80%; P=0.013). […] In addition, mPDAI response rates favoured vedolizumab over placebo after 14 weeks (62.7% vs 33.3%; P=0.003) and 34 weeks (51.0% vs 29.4%; P=0.026).

• #2 STELARA – Treatment of Pouchitis

  https://www.jnjmedicalconnect.com/products/stelara/medical-content/stelara-treatment-of-pouchitis

  A prospective and several retrospective studies evaluated the use of STELARA for the treatment of pouchitis. […] Additionally, case reports have described the use of STELARA for the treatment of pouchitis. […] At week 16, 27.3% and 54.5% of patients achieved steroid-free remission and response, respectively. […] At week 48, 36.4% and 54.5% of patients achieved steroid-free remission and response, respectively. […] At week 52, the mPDAI response rate for STELARA was 60%. […] Clinical response at 3 and 6 months was achieved in 65% and 68% of patients, respectively. […] Clinical response was achieved in 37 (80.4%) patients. […] Improvement in the extent/severity of pouch inflammation was seen in 7/10 (70%) patients with available endoscopic data following a median of 234 days from dose intensification.

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