Diagnosis and Medical Treatment of Acute and Chronic Idiopathic Pouchitis in Inflammatory Bowel Disease

• Published in: Medicina (Kaunas, Lithuania) Vol. 60; no. 6; p. 979
• Main Authors: Meianu, Corina, Stroie, Tudor, Istratescu, Doina, Preda, Carmen Monica, Diculescu, Mihai Mircea
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 01.06.2024; MDPI
• Subjects: Acute Disease; Adalimumab; Anti-Bacterial Agents - therapeutic use; Antibiotics; Antibodies, Monoclonal, Humanized - therapeutic use; Biological products; biologics; Care and treatment; Cholangitis; Chronic Disease; Clinical medicine; Clinical trials; Colitis, Ulcerative - complications; Colitis, Ulcerative - drug therapy; Colitis, Ulcerative - surgery; Development and progression; Diagnosis; Endoscopy; Genotype & phenotype; Health aspects; Humans; ileal pouch-anal anastomosis; Immunosuppressive agents; Immunotherapy; Inflammation; Inflammatory bowel disease; Inflammatory Bowel Diseases - complications; Inflammatory Bowel Diseases - surgery; Metronidazole; Microbiota; Pathogenesis; pouch; Pouchitis - diagnosis; Pouchitis - drug therapy; Pouchitis - etiology; Proctocolectomy, Restorative - adverse effects; Proctocolectomy, Restorative - methods; Review; Rifaximin; Small intestine; small molecules; Surgical anastomosis; Tinidazole; Tofacitinib; Ulcerative colitis; ulcerative colitis; biologics; ileal pouch-anal anastomosis; pouch; small molecules
• ISSN: 1648-9144; 1010-660X; 1648-9144
• DOI: 10.3390/medicina60060979

Despite the decreased rates in inflammatory bowel disease (IBD) colectomies due to high advances in therapeutic options, a significant number of patients still require proctocolectomy with ileal pouch-anal anastomosis (IPPA) for ulcerative colitis (UC). Pouchitis is the most common complication in these patients, where up to 60% develop one episode of pouchitis in the first two years after UC surgery with IPAA with severe negative impact on their quality of life. Acute cases usually respond well to antibiotics, but 15% of patients will still develop a refractory disease that requires the initiation of advanced immunosuppressive therapies. For chronic idiopathic pouchitis, current recommendations suggest using the same therapeutic options as for IBD in terms of biologics and small molecules. However, the available data are limited regarding the effectiveness of different biologics or small molecules for the management of this condition, and all evidences arise from case series and small studies. Vedolizumab is the only biologic agent that has received approval for the treatment of adult patients with moderately to severely active chronic refractory pouchitis. Despite the fact that IBD treatment is rapidly evolving with the development of novel molecules, the presence of pouchitis represents an exclusion criterion in these trials. Recommendations for the approach of these conditions range from low to very low certainty of evidence, resulting from small randomized controlled trials and case series studies. The current review focuses on the therapeutic management of idiopathic pouchitis.