Shah Mili, Masson Aarshdeep, Moparty Hamsika, Gala Dhir, Kumar Vikash
Internal Medicine, American University of the Caribbean School of Medicine, Cupecoy, SXM.
Internal Medicine, The Brooklyn Hospital Center, Brooklyn, USA.
Cureus. 2024 Feb 1;16(2):e53398. doi: 10.7759/cureus.53398. eCollection 2024 Feb.
Patients who undergo restorative proctocolectomy and ileoanal anastomosis can develop pouchitis as a common chronic complication. A rare subset of patients fails to respond to multiple antibiotic therapies and develop chronic antibiotic-refractory pouchitis (CARP). We present a case of a 45-year-old male with pouchitis refractory to chronic antibiotic therapy and histology demonstrating chronic inflammatory changes. Management involved mesalamine and probiotics, resulting in a positive clinical response and symptom absence on follow-up. This case highlights the intricacies of treating chronic pouchitis post ileoanal anastomosis, showcasing the efficacy of a personalized approach using mesalamine and probiotics. CARP is emerging as an entity associated with poor quality of life and increased healthcare costs. CARP fails to respond to multiple courses of antibiotic therapy. Therefore, the management of CARP is difficult and limited. Current literature on the management of CARP is scarce and mainly involves immunomodulatory therapy and probiotics. It is essential to keep this differential diagnosis in mind in patients with recurrent pouchitis episodes and start them on immunomodulator treatment and probiotics rather than repeated courses of antibiotics.
接受结直肠切除回肠肛管吻合术的患者可能会发生袋炎，这是一种常见的慢性并发症。一小部分罕见患者对多种抗生素治疗无反应，并发展为慢性抗生素难治性袋炎（CARP）。我们报告一例45岁男性患者，其袋炎对慢性抗生素治疗无效，组织学显示有慢性炎症改变。治疗包括使用美沙拉嗪和益生菌，随访时临床反应良好且症状消失。该病例突出了回肠肛管吻合术后慢性袋炎治疗的复杂性，展示了使用美沙拉嗪和益生菌的个性化治疗方法的有效性。CARP正成为一种与生活质量差和医疗费用增加相关的疾病。CARP对多疗程抗生素治疗无反应。因此，CARP的治疗困难且有限。目前关于CARP治疗的文献很少，主要涉及免疫调节治疗和益生菌。对于反复出现袋炎发作的患者，必须牢记这种鉴别诊断，并让他们开始接受免疫调节剂治疗和益生菌治疗，而不是重复使用抗生素疗程。
