Restorative proctocolectomy with ileal pouch anal anastomosis is considered the procedure of choice in patients with ulcerative colitis (UC) refractory to medical therapy.
The incidence of pouchitis is 40% at 5 years.
About 10% to 15% of patients with pouchitis experience chronic pouchitis.
Dr Segal and colleagues from the United Kingdom determined the efficacy of medical therapies for the treatment of chronic refractory pouchitis in patients undergoing ileal pouch anal anastomosis for UC.
A systematic computer-assisted search of the on-line bibliographic database MEDLINE and EMBASE was performed between 1966 and 2016.
|Antibiotics induced remission in patients with chronic pouchitis with 74% remission rate|
|Alimentary Pharmacology & Therapeutics|
All original studies reporting remission rates following medical treatment for chronic pouchitis were included.
All study designs were considered.
Remission was defined according to the individual study. Remission endpoints ranged from 15 days to 10 weeks.
Chronic pouchitis was defined by each study.
The research team found that 21 papers were considered eligible.
The team noted that results from all studies combined suggested that overall remission was obtained in 59% of patients.
The researchers observed that antibiotics significantly induced remission in patients with chronic pouchitis with 74% remission rate.
Biologics significantly induced remission in patients with chronic pouchitis with 53% remission rate.
The research team noted that steroids, bismuth, elemental diet and tacrolimus all can induce remission but failed to achieve significance.
The team noted that fecal microbiota transplantation in a single study was not found to achieve remission.
Dr Segal's team concludes, "Treatment of chronic refractory pouchitis remains difficult and is largely empirical."
"Larger randomized controlled trials will help aid the management of chronic pouchitis."