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Key Focus Areas in Pouchitis Therapeutic Status: A Narrative Review

Document Type : Review Article

Authors

1 Department of Internal Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

2 School of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada

3 Nutrition Research Center, Department of Clinical Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Science, Shiraz, Iran

4 Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

5 Center for Cohort Study of SUMS Employees’ Health, Shiraz University of Medical Sciences, Shiraz, Iran

10.30476/ijms.2024.100782.3326

Abstract

Pouchitis, as the most common complication after ileal pouch-anal anastomosis (IPAA), has an incidence from 7% to 46%. Pouchitis treatment still represents one of the biggest gaps of knowledge in the treatment of diseases. This review has focused on achievements and challenges in the treatment of pouchitis. A combined assessment of symptoms, endoscopic findings, histologic results, quick biomarkers, and fecal calprotectin test were determined to be valuable diagnostic criteria. Conventional therapy was described as a modification of bacterial flora, mainly with antibiotics and more recently with probiotics such as bifidobacteria, lactobacilli, and streptococci. Other therapeutic approaches such as anti-tumor necrosis factor, infliximab, adalimumab, vedolizumab, ustekinumab, tacrolimus, tofacitinib, thiopurines, corticosteroids, prolyl hydroxylase–containing enzymes, povidone-iodine, dextrose spray, fecal microbiota transplantation, herbal medicines, and leukocyte apheresis have been discussed. Changes in dietary components, and administration of complementary and alternative medicine, probiotics, and fecal transplantation in addition to conventional therapies were also shown to affect the outcome of disease. Due to the potential significant impairment in quality of life caused by pouchitis, it is essential to address the gaps in knowledge for both patients and physicians in its treatment. Therefore, well-designed and adequately powered studies should assess the optimal treatment for pouchitis. 

Keywords

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Iranian Journal of Medical Sciences
Volume 49, Issue 8
August 2024
Pages 472-486
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History
  • Received: 15 November 2023
  • Revised: 29 January 2024
  • Accepted: 08 March 2024
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