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The role of antibiotics and probiotics in pouchitis.

Gionchetti P, Calafiore A, Riso D, Liguori G, Calabrese C, Vitali G, Laureti S, Poggioli G, Campieri M, Rizzello F - Ann Gastroenterol (2012)

Bottom Line: Its frequency is related to the duration of the follow up, occurring in up to 50% of patients 10 years after IPAA in large series from major referral centers.Probiotics are living organisms, which, upon ingestion in certain numbers, exert health benefits beyond inherent basic nutrition.VSL#3, a highly concentrated cocktail of probiotics has been shown to be effective in the prevention of pouchitis onset and relapses.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Medicine (Paolo Gionchetti, Andrea Calafiore, Donatella Riso, Giuseppina Liguori, Carlo Calabrase, Massimo Campieri, Fernando Rizzello).

ABSTRACT
Pouchitis is a non-specific inflammation of the ileal reservoir and the most common complication of proctocolectomy with ileal pouch-anal anastomosis (IPAA) in patients with ulcerative colitis. Its frequency is related to the duration of the follow up, occurring in up to 50% of patients 10 years after IPAA in large series from major referral centers. Treatment of pouchitis is largely empirical and only small placebo-controlled trials have been conducted. The rationale for using probiotics and antibiotics in pouchitis is based on convincing evidence that implicates intestinal bacteria in the pathogenesis of this disease. Probiotics are living organisms, which, upon ingestion in certain numbers, exert health benefits beyond inherent basic nutrition. VSL#3, a highly concentrated cocktail of probiotics has been shown to be effective in the prevention of pouchitis onset and relapses. Antibiotics are the mainstay of treatment of pouchitis, and metronidazole and ciprofloxacin are the most common initial approaches, often with a rapid response. The use of antibiotics in pouchitis is largely justified although proper controlled trials have not been conducted.

No MeSH data available.


Related in: MedlinePlus

Proposed treatment algorithm in pouchitisCD, Crohn’s disease; CMV, Cytomegalovirus; AZA/6MP, azathioprine/6-mercaptopurine, GCS, glucocorticosteroids
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Figure 1: Proposed treatment algorithm in pouchitisCD, Crohn’s disease; CMV, Cytomegalovirus; AZA/6MP, azathioprine/6-mercaptopurine, GCS, glucocorticosteroids

Mentions: A proposed algorithm for treatment of pouchitis (Fig. 1) is that once diagnosis is confirmed by endoscopy and histology, the main treatment consists of metronidazole 250 mg TID or ciprofloxacin 500 mg BID for at least two weeks. In case of a subsequent prompt relapse the patients can be treated with a prolonged course of the same antibiotic or with a combined antibiotic treatment; in case of positive response we suggest to start maintenance treatment with highly concentrated probiotics. In refractory pouchitis, patients should be treated with other antibiotics or prolonged combined antibiotic treatment. Again, in case of response, maintenance probiotic treatment after stopping of antimicrobial agents is suggested. When no positive response is obtained one should try other types of treatment such as oral budesonide, corticosteroids, oral or topical salicylates, immunosuppressive agents or biologics. Patients who will be refractory to all forms of medical treatment should be referred to a surgeon for a redo-pouch or pouch excision.


The role of antibiotics and probiotics in pouchitis.

Gionchetti P, Calafiore A, Riso D, Liguori G, Calabrese C, Vitali G, Laureti S, Poggioli G, Campieri M, Rizzello F - Ann Gastroenterol (2012)

Proposed treatment algorithm in pouchitisCD, Crohn’s disease; CMV, Cytomegalovirus; AZA/6MP, azathioprine/6-mercaptopurine, GCS, glucocorticosteroids
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3959382&req=5

Figure 1: Proposed treatment algorithm in pouchitisCD, Crohn’s disease; CMV, Cytomegalovirus; AZA/6MP, azathioprine/6-mercaptopurine, GCS, glucocorticosteroids
Mentions: A proposed algorithm for treatment of pouchitis (Fig. 1) is that once diagnosis is confirmed by endoscopy and histology, the main treatment consists of metronidazole 250 mg TID or ciprofloxacin 500 mg BID for at least two weeks. In case of a subsequent prompt relapse the patients can be treated with a prolonged course of the same antibiotic or with a combined antibiotic treatment; in case of positive response we suggest to start maintenance treatment with highly concentrated probiotics. In refractory pouchitis, patients should be treated with other antibiotics or prolonged combined antibiotic treatment. Again, in case of response, maintenance probiotic treatment after stopping of antimicrobial agents is suggested. When no positive response is obtained one should try other types of treatment such as oral budesonide, corticosteroids, oral or topical salicylates, immunosuppressive agents or biologics. Patients who will be refractory to all forms of medical treatment should be referred to a surgeon for a redo-pouch or pouch excision.

Bottom Line: Its frequency is related to the duration of the follow up, occurring in up to 50% of patients 10 years after IPAA in large series from major referral centers.Probiotics are living organisms, which, upon ingestion in certain numbers, exert health benefits beyond inherent basic nutrition.VSL#3, a highly concentrated cocktail of probiotics has been shown to be effective in the prevention of pouchitis onset and relapses.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Medicine (Paolo Gionchetti, Andrea Calafiore, Donatella Riso, Giuseppina Liguori, Carlo Calabrase, Massimo Campieri, Fernando Rizzello).

ABSTRACT
Pouchitis is a non-specific inflammation of the ileal reservoir and the most common complication of proctocolectomy with ileal pouch-anal anastomosis (IPAA) in patients with ulcerative colitis. Its frequency is related to the duration of the follow up, occurring in up to 50% of patients 10 years after IPAA in large series from major referral centers. Treatment of pouchitis is largely empirical and only small placebo-controlled trials have been conducted. The rationale for using probiotics and antibiotics in pouchitis is based on convincing evidence that implicates intestinal bacteria in the pathogenesis of this disease. Probiotics are living organisms, which, upon ingestion in certain numbers, exert health benefits beyond inherent basic nutrition. VSL#3, a highly concentrated cocktail of probiotics has been shown to be effective in the prevention of pouchitis onset and relapses. Antibiotics are the mainstay of treatment of pouchitis, and metronidazole and ciprofloxacin are the most common initial approaches, often with a rapid response. The use of antibiotics in pouchitis is largely justified although proper controlled trials have not been conducted.

No MeSH data available.


Related in: MedlinePlus