Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA.
General Surgery Department, Colorectal Surgery Unit, Mansoura University Hospitals, Mansoura, Egypt.
J Gastrointest Surg. 2023 Nov;27(11):2650-2660. doi: 10.1007/s11605-023-05841-3. Epub 2023 Oct 10.
This systematic review explored different medications and methods for prevention and treatment of pouchitis after restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA).
PubMed, Scopus, and Web of Science were searched for randomized clinical trials that assessed prevention or treatment of pouchitis. The systematic review was reported in line with updated 2020 PRISMA guidelines. Risk of bias in the trials included was assessed using the ROB-2 tool and certainty of evidence was assessed using GRADE. The main outcomes were the incidence of new pouchitis episodes in the preventative studies and resolution or improvement of active pouchitis in the treatment studies.
Fifteen randomized trials were included. A meta-analysis of 7 trials on probiotics revealed significantly lower odds of pouchitis with the use of probiotics (RR: 0.26, 95% CI: 0.16-0.42, I = 20%, p < 0.001) and similar odds of adverse effects to placebo (RR: 2.43, 95% CI: 0.11-55.9, I = 0, p = 0.579). One trial investigated the prophylactic role of allopurinol in preventing pouchitis and found a comparable incidence of pouchitis in the two groups (31% vs 28%; p = 0.73). Seven trials assessed different treatments for active pouchitis. One recorded the resolution of pouchitis in all patients treated with ciprofloxacin versus 67% treated with metronidazole. Both budesonide enema and oral metronidazole were associated with similar significant improvement in pouchitis (58.3% vs 50%, p = 0.67). Rifaximin, adalimumab, fecal microbiota transplantation, and bismuth carbomer foam enema were not effective in treating pouchitis.
Probiotics are effective in preventing pouchitis after IPAA. Antibiotics, including ciprofloxacin and metronidazole, are likely effective in treating active pouchitis.
本系统评价探讨了直肠结肠切除回肠贮袋肛管吻合术（IPAA）后预防和治疗 pouchitis 的不同药物和方法。
在 PubMed、Scopus 和 Web of Science 上检索评估 pouchitis 预防或治疗的随机临床试验。系统评价按照 2020 年更新的 PRISMA 指南进行报告。纳入试验的偏倚风险使用 ROB-2 工具进行评估，证据确定性使用 GRADE 进行评估。主要结局是预防研究中新 pouchitis 发作的发生率和治疗研究中活动性 pouchitis 的缓解或改善。
纳入了 15 项随机试验。对 7 项益生菌研究的荟萃分析显示，使用益生菌的 pouchitis 发生率显著降低（RR：0.26，95%CI：0.16-0.42，I=20%，p<0.001），与安慰剂相比不良反应的发生率相似（RR：2.43，95%CI：0.11-55.9，I=0，p=0.579）。一项试验研究了别嘌呤醇在预防 pouchitis 中的预防作用，发现两组 pouchitis 的发生率相似（31% vs 28%；p=0.73）。7 项试验评估了活动性 pouchitis 的不同治疗方法。一项研究记录了所有接受环丙沙星治疗的患者中 pouchitis 的缓解率为 100%，而接受甲硝唑治疗的患者中为 67%。布地奈德灌肠剂和口服甲硝唑均与 pouchitis 的显著改善相关（58.3% vs 50%，p=0.67）。利福昔明、阿达木单抗、粪便微生物移植和双八面体蒙脱石泡沫灌肠剂在治疗 pouchitis 方面无效。
益生菌对 IPAA 后 pouchitis 的预防有效。抗生素，包括环丙沙星和甲硝唑，可能对治疗活动性 pouchitis 有效。
