Alsakarneh Saqr, Camilleri Michael, Farraye Francis A, Hashash Jana G
Department of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA.
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
Dig Dis Sci. 2025 Apr 16. doi: 10.1007/s10620-025-09039-2.
Bile acid sequestrants (BAS) are an emerging option for treatment of pouchitis. We aimed to compare BAS monotherapy, antibiotics, and combination therapy with both in the treatment of pouchitis after ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC).
We conducted a retrospective cohort study using the US-Collaborative TriNetX database to identify patients with acute pouchitis and UC. Treatment groups were divided into BAS (cholestyramine, colesevelam, colestipol), antibiotics (ciprofloxacin and/or metronidazole), and combination therapy of both BAS and antibiotics. Primary outcomes were failure of initial therapy (early relapse or nonresponse) and the development of recurrent pouchitis in the first 12 months after an initial episode of pouchitis.
Our analysis included 1,136 patients (mean age: 37.8 ± 15.4 years, and 45.9% female) of whom 727 (64%) were diagnosed with recurrent pouchitis. After adjusting for confounders by propensity-score matching, there was no significant difference in the odds of early relapse or nonresponse with BAS compared with antibiotic monotherapy (aOR: 0.74; 95% CI: 0.40-1.38; p = 0.34) or combination therapy (aOR: 0.94; 95% CI: 0.47-1.88; p = 0.86). Patients treated with BAS had a statistically significant lower recurrent pouchitis rate (aHR: 0.57; 95% CI: 0.42-0.79; p < 0.001) compared with patients treated with antibiotics. Patients treated with BAS had a statistically significant longer time (median: 225 days) to recurrent pouchitis (p < 0.001) compared to antibiotics (median: 99 days).
Using real-world evidence regarding treatment of pouchitis compared to standard antibiotic therapy, BAS monotherapy was not inferior for initial treatment response and significantly prolonged time to recurrent pouchitis.
胆汁酸螯合剂（BAS）是治疗袋炎的一种新兴选择。我们旨在比较BAS单药治疗、抗生素治疗以及两者联合治疗在溃疡性结肠炎（UC）回肠储袋肛管吻合术（IPAA）后袋炎治疗中的效果。
我们使用美国协作TriNetX数据库进行了一项回顾性队列研究，以确定急性袋炎和UC患者。治疗组分为BAS（考来烯胺、考来维仑、考来替泊）、抗生素（环丙沙星和/或甲硝唑）以及BAS与抗生素联合治疗组。主要结局为初始治疗失败（早期复发或无反应）以及在袋炎首次发作后的前12个月内复发性袋炎的发生情况。
我们的分析纳入了1136例患者（平均年龄：37.8±15.4岁，女性占45.9%），其中727例（64%）被诊断为复发性袋炎。通过倾向评分匹配调整混杂因素后，与抗生素单药治疗相比，BAS治疗早期复发或无反应的几率无显著差异（调整后比值比：0.74；95%置信区间：0.40 - 1.38；p = 0.34），与联合治疗相比也无显著差异（调整后比值比：0.94；95%置信区间：0.47 - 1.88；p = 0.86）。与接受抗生素治疗的患者相比，接受BAS治疗的患者复发性袋炎发生率在统计学上显著更低（调整后风险比：0.57；95%置信区间：0.42 - 0.79；p < 0.001）。与抗生素治疗（中位数：99天）相比，接受BAS治疗的患者复发性袋炎的时间在统计学上显著更长（中位数：225天）（p < 0.001）。
与标准抗生素治疗相比，利用关于袋炎治疗的真实世界证据，BAS单药治疗在初始治疗反应方面并不逊色，且显著延长了复发性袋炎的发作时间。
