Outtier An, Ferrante Marc
Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
Clin Exp Gastroenterol. 2021 Jun 14;14:277-290. doi: 10.2147/CEG.S219556. eCollection 2021.
Pouchitis is the most common long-term complication in patients with ulcerative colitis who underwent restorative proctocolectomy with ileal pouch-anal anastomosis. The incidence of acute pouchitis is 20% after 1 year and up to 40% after 5 years. Chronic antibiotic-refractory pouchitis develops in approximately 10% of patients.
To present a narrative review of published literature regarding the management of chronic antibiotic-refractory pouchitis.
Current relevant literature was summarized and critically evaluated.
Clear definitions should be used to classify pouchitis into acute versus chronic, and responsive versus dependent versus refractory to antibiotics. Before treatment is started for chronic antibiotic-refractory pouchitis, secondary causes should be ruled out. There is a need for validated scoring systems to measure the severity of the disease. Because chronic antibiotic-refractory pouchitis is a rare condition, only small studies with often a poor study design have been performed. Treatments with antibiotics, aminosalicylates, steroids, immunomodulators and biologics have shown to be effective and safe for chronic antibiotic-refractory pouchitis. Also, treatments with AST-120, hyperbaric oxygen therapy, tacrolimus enemas, and granulocyte and monocyte apheresis suggested some efficacy.
The available data are weak but suggest that therapeutic options for chronic antibiotic-refractory pouchitis are similar to the treatment strategies for inflammatory bowel diseases. However, randomized controlled trials are warranted to further identify the best treatment options in this patient population.
在接受回肠储袋肛管吻合术的溃疡性结肠炎患者中，储袋炎是最常见的长期并发症。急性储袋炎的发病率在术后1年为20%，5年后高达40%。约10%的患者会发展为慢性抗生素难治性储袋炎。
对已发表的关于慢性抗生素难治性储袋炎治疗的文献进行叙述性综述。
对当前相关文献进行总结和严格评估。
应使用明确的定义将储袋炎分为急性与慢性，以及对抗生素有反应、依赖或难治。在开始治疗慢性抗生素难治性储袋炎之前，应排除继发原因。需要经过验证的评分系统来衡量疾病的严重程度。由于慢性抗生素难治性储袋炎是一种罕见疾病，仅进行了一些研究设计往往较差的小型研究。抗生素、氨基水杨酸类药物、类固醇、免疫调节剂和生物制剂治疗已显示对慢性抗生素难治性储袋炎有效且安全。此外，AST - 120治疗、高压氧治疗、他克莫司灌肠以及粒细胞和单核细胞分离术也显示出一定疗效。
现有数据薄弱，但表明慢性抗生素难治性储袋炎的治疗选择与炎症性肠病的治疗策略相似。然而，需要进行随机对照试验以进一步确定该患者群体的最佳治疗选择。
