Pouchitis is inflammation of the artificial reservoir or rectum (referred to as a “pouch”) following surgery for removal of the rectum.
Incidence
Acute pouchitis occurs in approximately 15% of pouches. This usually responds to a course of antibiotics. Antibiotic resistant refractory pouchitis is more difficult to manage, and fortunately less common occurring in only 5% of cases. Other causes for pouchitis may include smoking, poorly controlled disease, or un-recognised Crohn’s disease.
Medical management of pouchitis
Pouchitis usually responds to oral antibiotics (ciprofloxicin or flagyl). Resistant cases require a visit to your colorectal surgeon where a biopsy will be needed. Bacterial overgrowth often responds to Probiotics such as VSL#3®, with the usual dose 6g/day. This contains the health bacteria that normally line the gut and protects against overgrowth by unhealthy bacteria [2-4].
Resistant cases of chronic pouchitis will require the involvement of you gastroenterologist, with consideration of immune modulating agents including steroids such as prednisone, azathoprine, and occasionally infliximab®
Surgery for pouchitis
Occasionally further surgery is required for medically resistant chronic pouchitis. Usually revision surgery is possible, although re-do pouch surgery is sometimes required. On rare occasions, removal of the pouch with formation of a permanent ileosotomy is required.
Reference
- Mimura T RF, Helwig U, et al. Once daily high dose probiotic therapy (VSL#3) for maintenance remission in recurrent or refractory pouchitis. Gut 2004;53:108-14.
- Gionchetti P RF, Helwig U, et al. Prophylaxis of pouchitis onset with probiotic therapy: A double-blind, placebo-controlled trial. Gastroenterology 2003;124:1202-9.
- Gionchetti P RF, Venturi A, et al. Oral bacteriotherapy as maintenance treatment in patients with chronic pouchitis: A double-blinded, placebo-controlled trial. Gastroenterology. 2000;119:305-9.
