Department of Internal Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
School of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada.
Iran J Med Sci. 2024 Aug 1;49(8):472-486. doi: 10.30476/ijms.2024.100782.3326. eCollection 2024 Aug.
Pouchitis, as the most common complication after ileal pouch-anal anastomosis (IPAA), has an incidence from 7% to 46%. Pouchitis treatment still represents one of the biggest gaps of knowledge in the treatment of diseases. This review has focused on achievements and challenges in the treatment of pouchitis. A combined assessment of symptoms, endoscopic findings, histologic results, quick biomarkers, and fecal calprotectin test were determined to be valuable diagnostic criteria. Conventional therapy was described as a modification of bacterial flora, mainly with antibiotics and more recently with probiotics such as bifidobacteria, lactobacilli, and streptococci. Other therapeutic approaches such as anti-tumor necrosis factor, infliximab, adalimumab, vedolizumab, ustekinumab, tacrolimus, tofacitinib, thiopurines, corticosteroids, prolyl hydroxylase-containing enzymes, povidone-iodine, dextrose spray, fecal microbiota transplantation, herbal medicines, and leukocyte apheresis have been discussed. Changes in dietary components, and administration of complementary and alternative medicine, probiotics, and fecal transplantation in addition to conventional therapies were also shown to affect the outcome of disease. Due to the potential significant impairment in quality of life caused by pouchitis, it is essential to address the gaps in knowledge for both patients and physicians in its treatment. Therefore, well-designed and adequately powered studies should assess the optimal treatment for pouchitis.
pouchitis 是回肠贮袋肛管吻合术后（IPAA）最常见的并发症，其发病率为 7%至 46%。 pouchitis 的治疗仍然是疾病治疗中知识差距最大的问题之一。本综述重点介绍了 pouchitis 治疗方面的成就和挑战。综合评估症状、内镜表现、组织学结果、快速生物标志物和粪便钙卫蛋白检测被确定为有价值的诊断标准。常规治疗被描述为对细菌菌群的修饰，主要使用抗生素，最近还使用双歧杆菌、乳杆菌和链球菌等益生菌。其他治疗方法，如抗肿瘤坏死因子、英夫利昔单抗、阿达木单抗、vedolizumab、ustekinumab、他克莫司、托法替尼、硫唑嘌呤、皮质类固醇、脯氨酰羟化酶含酶、聚维酮碘、葡萄糖喷雾、粪便微生物群移植、草药和白细胞吸附，也进行了讨论。饮食成分的变化、补充和替代医学、益生菌和粪便移植的应用除了常规治疗外，还被证明会影响疾病的结果。由于 pouchitis 可能导致生活质量显著受损，因此解决患者和医生在其治疗方面的知识差距至关重要。因此，应进行精心设计和充分有效的研究，以评估 pouchitis 的最佳治疗方法。
