Overall, 10 to 15% of patients with pouchitis experience refractory or recurrent disease.
In this study, researchers from Europe evaluated a high dose probiotic preparation (VSL#3) in maintaining antibiotic induced remission and quality of life (QOL) in these patients.
The team included patients with pouchitis at least twice in the previous year or requiring continuous antibiotics, associated with a pouchitis disease activity index (PDAI) 7.
|Remission at 1 year:|
- VSL#3 = 85%
- placebo = 6%.
Patients had remission induced by 4 weeks of combined metronidazole and ciprofloxacin.
They were randomized to receive VSL#3 6 g (n=20) or placebo (n=16) once daily for 1 year or until relapse.
Remission was defined as a clinical PDAI 2 and endoscopic PDAI 1.
Relapse was defined as an increased clinical PDAI score 2 and increased endoscopic PDAI score 3.
QOL was assessed using the inflammatory bowel disease questionnaire (IBDQ).
The researchers found that remission was maintained at 1 year in 85% of patients in the VSL#3 group, and in 6% in the placebo group.
Furthermore, patients IBDQ score remained high in the VSL#3 group, but deteriorated in the placebo group.
Dr Mimura's team concluded, "The once daily high dose probiotic VSL#3 is effective in maintaining antibiotic introduced remission for at least a year in patients with recurrent or refractory pouchitis".
"This is associated with a high level of quality of life".