A 29-year-old woman with ulcerative colitis underwent total colectomy with ileal-pouch-anal canal anastomosis in 1999. After the surgery, she developed refractory pouchitis. We administered metronidazole, mesalamine and ciprofloxacin; however, her clinical symptoms improved only very slightly. We initiated treatment with infliximab in June 2011 and discontinued the antibiotics. Thereafter, the patient's abdominal symptoms quickly improved. We discontinued the infliximab therapy in June 2012, after which time, the patient's abdominal symptoms remained in remission for 40 weeks, without the use of antibiotics. This report suggests that infliximab is useful not only for improving the clinical symptoms of refractory pouchitis, but also discontinuing antibiotic therapy in such patients.
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Incidence, Risk Factors, and Outcomes of Chronic Antibiotic-Refractory Pouchitis in Korean Patients with Ulcerative Colitis.
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Background/aims: The study investigated the incidence, risk factors, and clinical outcomes of chronic antibiotic-refractory pouchitis (CARP) in Korean patients with ulcerative colitis (UC).
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Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel.
Background: Patients with ulcerative colitis (UC) undergoing proctocolectomy and ileal pouch-anal anastomosis (IPAA) may eventually require biologic therapy. Factors associated with biologic therapy after IPAA have not been previously studied.
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We present the case of a 64-year-old male diagnosed with corticosteroid-dependent ulcerative colitis in 1999, who underwent total proctocolectomy with a J-pouch in 2005. Three years later, he developed recurrent histologically confirmed pouchitis, with clinical worsening. Several therapies were tried, including Infliximab, which provided stability for six years, until the development of antibodies led to moderate pouchitis in the rectal stump.
View Article and Find Full Text PDFMedical Therapies for Prevention and Treatment of Inflammatory Pouch Disorders-A Systematic Review and Meta-Analysis.
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Article Synopsis
- - Ulcerative colitis (UC) treatment includes both conventional and advanced options like biological therapies and small molecules; surgery, such as ileal pouch-anal anastomosis (IPAA), is recommended for severe cases but can lead to complications.
- - Chronic pouchitis, especially antibiotic-dependent (CADP) and antibiotic-refractory (CARP) types, poses significant treatment challenges due to insufficient evidence for effective options.
- - Promising results have been observed with biological therapies like vedolizumab and small molecules like JAK inhibitors; however, further quality research and clinical monitoring are necessary to establish reliable treatment guidelines.
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