Unidad EII, Servicio de Aparato Digestivo, Hospital Clínico Universitario de Santiago, Santiago de Compostela, España.
Servicio de Aparato Digestivo, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Hospital General Universitario Gregorio Marañón, Madrid, España.
Gastroenterol Hepatol. 2020 Dec;43(10):649-658. doi: 10.1016/j.gastrohep.2020.04.004. Epub 2020 Jun 27.
Pouchitis treatment is a complex entity that requires a close medical and surgical relationship. The elective treatment for acute pouchitis is antibiotics. After a first episode of pouchitis it is recommended prophylaxis therapy with a probiotic mix, nevertheless it is not clear the use of this formulation for preventing a first episode of pouchitis after surgery. First-line treatment for chronic pouchitis is an antibiotic combination. The next step in treatment should be oral budesonide. Selected cases of severe, chronic refractory pouchitis may benefit from biologic agents, and anti-TNF α should be recommended as the first option, leaving the new biologicals for multi-refractory patients. Permanent ileostomy may be an option in severe refractory cases to medical treatment.
袋炎的治疗是一个复杂的实体，需要密切的医疗和手术关系。急性袋炎的选择性治疗是抗生素。在第一次袋炎发作后，建议使用益生菌混合物进行预防治疗，但对于预防手术后第一次袋炎发作，这种制剂的使用并不明确。慢性袋炎的一线治疗是抗生素联合治疗。治疗的下一步应该是口服布地奈德。对于严重、慢性难治性袋炎的选定病例，生物制剂可能有益，并且应推荐抗 TNF-α作为首选，将新的生物制剂留给多耐药患者。在严重难治性病例中，永久性回肠造口术可能是一种选择。
