From the Research
Treatment Options for Diversion Colitis
The treatment for diversion colitis is varied and depends on several factors, including the severity of symptoms and the patient's overall health. Some of the treatment options include:
- Short-chain fatty acid (SCFA) irrigation, which has been shown to be effective in reducing symptoms and inflammation 1
- Steroid enemas, 5-aminosalicylic acid enemas or suppositories, which can be used to treat symptomatic patients 2
- Probiotics, which have recently been reported to be useful in treating diversion colitis 3
- Fecal microbiota transplantation (FMT), which has emerged as a promising treatment for diversion colitis due to its low medical costs, ease of use, and minimal side effects 3
- Irrigation with fibers, which has been attempted as a treatment approach, although its efficacy is variable 3
- Leukocytapheresis, dextrose (hypertonic glucose) spray, infliximab, an elemental diet, and coconut oil, which have been reported to have limited effect in individual case reports 3
- Endoscopic treatment with high-concentration dextrose spray, which has been used to treat bleeding diversion pouchitis 4
Surgical Intervention
In some cases, surgical intervention may be necessary, such as:
- Re-establishment of intestinal continuity, which is the only curative intervention available for patients with diversion pouchitis, proctitis, or colitis 4
- Resection of the excluded bowel, which may be considered for patients with permanent diversion and persistent symptoms despite medical treatment 2
Medical Management
Medical management of diversion colitis may involve:
- Topical treatment with 5-aminosalicylic acid (5-ASA), which is effective in inducing and maintaining remission of symptoms and mucosal inflammation 5
- Oral aminosalicylates, which are effective in both distal and extensive mild-to-moderate disease 5
- Corticosteroids, which may be used to treat severe disease or unresponsive cases 5