What is the treatment for pouchitis (inflammation of the ileal pouch)

From the Guidelines

Pouchitis treatment primarily involves antibiotics, with ciprofloxacin and/or metronidazole being the preferred antibiotics for treatment, according to the most recent guidelines 1. The typical duration of antibiotic therapy for the treatment of pouchitis is 2–4 weeks, as stated in the AGA clinical practice guideline on the management of pouchitis and inflammatory pouch disorders 1. Some key points to consider in the treatment of pouchitis include:

• The use of ciprofloxacin and/or metronidazole as first-line therapy, with the option to use alternative antibiotic regimens such as oral vancomycin in patients who do not respond to initial treatment or have allergies or intolerance to ciprofloxacin and/or metronidazole 1.
• The consideration of combination therapy with both antibiotics for patients who do not respond to single-antibiotic therapy 1.
• The potential use of probiotics, such as VSL#3, to maintain remission after antibiotic treatment, although the evidence for this is not strong 1.
• The option to use chronic antibiotic therapy or advanced immunosuppressive therapies, such as TNF-α antagonists or vedolizumab, in patients with chronic antibiotic-dependent pouchitis or recurrent pouchitis that responds to antibiotics but relapses shortly after stopping antibiotics 1. It is essential to note that the treatment of pouchitis should be individualized based on the patient's specific needs and circumstances, and that the use of antibiotics and other therapies should be guided by the most recent clinical practice guidelines and evidence-based recommendations 1.

From the Research

Treatment Options for Pouchitis

The treatment for pouchitis, an inflammation of the ileal pouch, typically involves the use of antibiotics and probiotics.

• Broad-spectrum antibiotics, such as metronidazole and ciprofloxacin, are the mainstay of treatment for pouchitis 2, 3, 4, 5.
• Probiotics, particularly the highly concentrated probiotic mixture VSL#3, have been shown to be effective in preventing pouchitis onset and maintaining antibiotic-induced remission 2, 4, 5.
• In cases of severe or refractory pouchitis, other treatments such as rebamipide may be considered 3.

Antibiotic Treatment

Antibiotic treatment is often effective in reducing symptoms of pouchitis, but may also have unintended consequences, such as:

• Reducing beneficial bacterial species 6
• Enriching for antibiotic-resistant bacterial strains 6
• Leading to relapse after treatment cessation 6

Probiotic Treatment

Probiotic treatment, on the other hand, may help to:

• Prevent pouchitis onset 2, 4, 5
• Maintain remission after antibiotic treatment 2, 4
• Improve quality of life for patients with pouchitis 2