Desk A-30, Department of Colorectal Surgery, Digestive Disease Institute Cleveland Clinic, 9500 Euclid Ave. Cleveland, OH 44195, USA.
Curr Drug Targets. 2019;20(13):1399-1408. doi: 10.2174/1389450120666190723130137.
Approximately 50% of patients who have undergone IPAA surgery for Ulcerative Colitis (UC) develop at least 1 episode of pouchitis. Patients with pouchitis have a wide range of symptoms, endoscopic and histologic features, disease course, and prognosis. To date, there are no universally accepted diagnostic criteria in terms of endoscopy and histology; though, semi-objective assessments to diagnose pouchitis in patients with ileal pouch- anal anastomosis (IPAA) have been proposed using composite scores such as the Pouchitis Triad, Heidelberg Pouchitis Activity Score and Pouchitis Disease Activity Index (PDAI). In a systematic review that included four randomized trials evaluating five agents for the treatment of acute pouchitis, ciprofloxacin was more effective at inducing remission as compared with metronidazole. Rifaximin was not more effective than placebo, while budesonide enemas and metronidazole were similarly effective for inducing remission of acute pouchitis. Patients with pouchitis relapsing more than three times per year are advised maintenance therapy, and guidelines recommend ciprofloxacin or the probiotic VSL#3. In patients with antibiotic-refractory pouchitis, secondary factors associated with an antibiotic-refractory course should be sought and treated. In this review, we will discuss the prevention and management of pouchitis in Ulcerative Colitis patients.
约有 50%接受回肠储袋肛管吻合术（IPAA）治疗溃疡性结肠炎（UC）的患者至少发生 1 次 pouchitis。 pouchitis 患者的症状、内镜和组织学特征、病程和预后差异很大。迄今为止，内镜和组织学方面尚无普遍接受的诊断标准；然而，已经提出了使用复合评分（如 pouchitis 三联征、海德堡 pouchitis 活动评分和 pouchitis 疾病活动指数）来诊断 IPAA 患者 pouchitis 的半客观评估。在一项纳入四项随机试验的系统评价中，评估了五种药物治疗急性 pouchitis 的效果，环丙沙星在诱导缓解方面比甲硝唑更有效。利福昔明并不比安慰剂更有效，而布地奈德灌肠剂和甲硝唑在诱导急性 pouchitis 缓解方面同样有效。每年复发 pouchitis 超过 3 次的患者建议进行维持治疗，指南推荐使用环丙沙星或益生菌 VSL#3。对于抗生素难治性 pouchitis 患者，应寻找并治疗与抗生素难治性病程相关的次要因素。在本次综述中，我们将讨论溃疡性结肠炎患者 pouchitis 的预防和管理。
