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Pharmacotherapy for acute pouchitis.
Ann Pharmacother. 2011 Sep; 45(9):1127-37.AP

Abstract

OBJECTIVE

To review the current literature concerning the medical treatment of acute and chronic pouchitis.

DATA SOURCES

MEDLINE and International Pharmaceutical Abstracts were searched (both 1965-February 2011) using the following terms: pouchitis, Crohn's, ulcerative colitis, diagnosis, prophylaxis, and treatment. Bibliographies from key articles were also searched, and all pertinent articles were reviewed.

STUDY SELECTION AND DATA EXTRACTION

All available primary literature published in English on treatment for pouchitis was considered, with controlled trials receiving highest priority.

DATA SYNTHESIS

Pouchitis occurs in up to 50% of ileal pouch-anal anastomosis (IPAA) patients with inflammatory bowel disease within 10 years of the procedure. Symptoms include abdominal pain, bloating, and fecal incontinence with frequent diarrhea. The diagnosis of pouchitis is usually made based on symptoms as well as endoscopic and histologic findings. Treatment of acute pouchitis includes antimicrobials such as ciprofloxacin, metronidazole, and rifaximin. If these fail, limited data suggest that oral budesonide, mesalamine, or infliximab may be effective treatments. Surgical revision may be necessary if medical treatments fail. Emerging evidence suggests that the probiotic compound VSL#3 may be effective in preventing the recurrence of pouchitis.

CONCLUSIONS

Pouchitis is a common complication of IPAA surgery. The strongest data suggest that antimicrobial therapy is an effective first-line treatment for acute pouchitis, and VSL#3 may be effective for prevention of recurrence.

Authors+Show Affiliations

Iowa Inflammatory Bowel Disease Center, Des Moines, IA, USA. geoff.wall@drake.eduNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

21775695

Citation

Wall, Geoffrey C., et al. "Pharmacotherapy for Acute Pouchitis." The Annals of Pharmacotherapy, vol. 45, no. 9, 2011, pp. 1127-37.
Wall GC, Schirmer LL, Anliker LE, et al. Pharmacotherapy for acute pouchitis. Ann Pharmacother. 2011;45(9):1127-37.
Wall, G. C., Schirmer, L. L., Anliker, L. E., & Tigges, A. E. (2011). Pharmacotherapy for acute pouchitis. The Annals of Pharmacotherapy, 45(9), 1127-37. https://doi.org/10.1345/aph.1P790
Wall GC, et al. Pharmacotherapy for Acute Pouchitis. Ann Pharmacother. 2011;45(9):1127-37. PubMed PMID: 21775695.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pharmacotherapy for acute pouchitis. AU - Wall,Geoffrey C, AU - Schirmer,Lori L, AU - Anliker,Lynn E, AU - Tigges,Ashley E, Y1 - 2011/07/20/ PY - 2011/7/22/entrez PY - 2011/7/22/pubmed PY - 2011/12/21/medline SP - 1127 EP - 37 JF - The Annals of pharmacotherapy JO - Ann Pharmacother VL - 45 IS - 9 N2 - OBJECTIVE: To review the current literature concerning the medical treatment of acute and chronic pouchitis. DATA SOURCES: MEDLINE and International Pharmaceutical Abstracts were searched (both 1965-February 2011) using the following terms: pouchitis, Crohn's, ulcerative colitis, diagnosis, prophylaxis, and treatment. Bibliographies from key articles were also searched, and all pertinent articles were reviewed. STUDY SELECTION AND DATA EXTRACTION: All available primary literature published in English on treatment for pouchitis was considered, with controlled trials receiving highest priority. DATA SYNTHESIS: Pouchitis occurs in up to 50% of ileal pouch-anal anastomosis (IPAA) patients with inflammatory bowel disease within 10 years of the procedure. Symptoms include abdominal pain, bloating, and fecal incontinence with frequent diarrhea. The diagnosis of pouchitis is usually made based on symptoms as well as endoscopic and histologic findings. Treatment of acute pouchitis includes antimicrobials such as ciprofloxacin, metronidazole, and rifaximin. If these fail, limited data suggest that oral budesonide, mesalamine, or infliximab may be effective treatments. Surgical revision may be necessary if medical treatments fail. Emerging evidence suggests that the probiotic compound VSL#3 may be effective in preventing the recurrence of pouchitis. CONCLUSIONS: Pouchitis is a common complication of IPAA surgery. The strongest data suggest that antimicrobial therapy is an effective first-line treatment for acute pouchitis, and VSL#3 may be effective for prevention of recurrence. SN - 1542-6270 UR - https://www.unboundmedicine.com/medline/citation/21775695/Pharmacotherapy_for_acute_pouchitis_ L2 - http://journals.sagepub.com/doi/full/10.1345/aph.1P790?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -