1932

Abstract

Chronic pouchitis (CP) occurs in approximately 20% of patients with ulcerative colitis after total proctocolectomy with ileal pouch anal anastomosis and is categorized as antibiotic dependent, antibiotic refractory, or Crohn's disease–like. The management of CP is challenging because of limited evidence and few randomized controlled trials. In this review, we discuss the medical management of CP and its supporting data delineated by type of therapy.

Loading

Article metrics loading...

/content/journals/10.1146/annurev-med-032224-120544
2025-01-27
2025-02-07
Loading full text...

Full text loading...

/deliver/fulltext/med/76/1/annurev-med-032224-120544.html?itemId=/content/journals/10.1146/annurev-med-032224-120544&mimeType=html&fmt=ahah

Literature Cited

  1. 1.
    Fazio VW, Ziv Y, Church JM, et al. 1995.. Ileal pouch–anal anastomoses complications and function in 1005 patients. . Ann. Surg. 222::12027
    [Google Scholar]
  2. 2.
    Shen B. 2012.. Acute and chronic pouchitis—pathogenesis, diagnosis and treatment. . Nat. Rev. Gastroenterol. Hepatol. 9::32333
    [Google Scholar]
  3. 3.
    Zezos P, Saibil F. 2015.. Inflammatory pouch disease: the spectrum of pouchitis. . World J. Gastroenterol. 21::873952
    [Google Scholar]
  4. 4.
    Quinn KP, Raffals LE. 2020.. An update on the medical management of inflammatory pouch complications. . Am. J. Gastroenterol. 115::143950
    [Google Scholar]
  5. 5.
    Shen B, Yu C, Lian L, et al. 2012.. Prediction of late-onset pouch failure in patients with restorative proctocolectomy with a nomogram. . J. Crohn's Colitis 6::198206
    [Google Scholar]
  6. 6.
    Tulchinsky H, Hawley PR, Nicholls J. 2003.. Long-term failure after restorative proctocolectomy for ulcerative colitis. . Ann. Surg. 238::22934
    [Google Scholar]
  7. 7.
    Barnes EL, Kochar B, Jessup HR, et al. 2019.. The incidence and definition of Crohn's disease of the pouch: a systematic review and meta-analysis. . Inflamm. Bowel Dis. 25::147480
    [Google Scholar]
  8. 8.
    Shen B, Kochhar GS, Rubin DT, et al. 2022.. Treatment of pouchitis, Crohn's disease, cuffitis, and other inflammatory disorders of the pouch: consensus guidelines from the International Ileal Pouch Consortium. . Lancet Gastroenterol. Hepatol. 7::6995
    [Google Scholar]
  9. 9.
    Barnes EL, Agrawal M, Syal G, et al. 2024.. AGA clinical practice guideline on the management of pouchitis and inflammatory pouch disorders. . Gastroenterology 166::5985
    [Google Scholar]
  10. 10.
    Mimura T, Rizzello F, Helwig U, et al. 2002.. Four-week open-label trial of metronidazole and ciprofloxacin for the treatment of recurrent or refractory pouchitis. . Aliment. Pharmacol. Ther. 6::90917
    [Google Scholar]
  11. 11.
    Shen B, Remzi FH, Lopez AR, et al. 2008.. Rifaximin for maintenance therapy in antibiotic-dependent pouchitis. . BMC Gastroenterol. 8::26
    [Google Scholar]
  12. 12.
    Shore BM, Weaver KN, Allegretti JR, et al. 2023.. Prevalence of Clostridioides difficile infection after ileal pouch–anal anastomosis in patients with chronic antibiotic-dependent pouchitis and Crohn's-like disease of the pouch. . Inflamm. Bowel Dis. 29::93237
    [Google Scholar]
  13. 13.
    Shen B, Fazio VW, Remzi FH, et al. 2007.. Combined ciprofloxacin and tinidazole therapy in the treatment of chronic refractory pouchitis. . Dis. Colon Rectum 50::498508
    [Google Scholar]
  14. 14.
    Ardalan ZS, Sparrow MP. 2019.. A personalized approach to managing patients with an ileal pouch–anal anastomosis. . Front. Med. 6::337
    [Google Scholar]
  15. 15.
    Chopra A, Pardi DS, Loftus EV Jr., et al. 2006.. Budesonide in the treatment of inflammatory bowel disease: the first year of experience in clinical practice. . Inflamm. Bowel Dis. 12::2932
    [Google Scholar]
  16. 16.
    Gionchetti P, Rizzello F, Poggioli G, et al. 2007.. Oral budesonide in the treatment of chronic refractory pouchitis. . Aliment. Pharmacol. Ther. 25::123136
    [Google Scholar]
  17. 17.
    Gionchetti P, Calabrese C, Calafiore A, et al. 2014.. Oral beclomethasone dipropionate in chronic refractory pouchitis. . J Crohn's Colitis 8::64953
    [Google Scholar]
  18. 18.
    Chandan S, Mohan BP, Kumar A, et al. 2021.. Safety and efficacy of biological therapy in chronic antibiotic refractory pouchitis: a systematic review with meta-analysis. . J. Clin. Gastroenterol. 55::48191
    [Google Scholar]
  19. 19.
    Kayal M, Lambin T, Plietz M, et al. 2020.. Recycling of precolectomy anti-tumor necrosis factor agents in chronic pouch inflammation is associated with treatment failure. . Clin. Gastroenterol. Hepatol. 19::149193.e3
    [Google Scholar]
  20. 20.
    Barreiro-de Acosta M, García-Bosch O, Souto R, et al. 2012.. Efficacy of infliximab rescue therapy in patients with chronic refractory pouchitis: a multicenter study. . Inflamm. Bowel Dis. 18::81217
    [Google Scholar]
  21. 21.
    Kjær MD, Qvist N, Nordgaard-Lassen I, et al. 2019.. Adalimumab in the treatment of chronic pouchitis. A randomized double-blind, placebo-controlled trial. . Scand. J. Gastroenterol. 54::18893
    [Google Scholar]
  22. 22.
    Barreiro-de Acosta M, García-Bosch O, Gordillo J, et al. 2012.. Efficacy of adalimumab rescue therapy in patients with chronic refractory pouchitis previously treated with infliximab: a case series. . Eur. J. Gastroenterol. Hepatol. 24::75658
    [Google Scholar]
  23. 23.
    Shen B, Remzi FH, Lavery IC, et al. 2009.. Administration of adalimumab in the treatment of Crohn's disease of the ileal pouch. . Aliment. Pharmacol. Ther. 29::51926
    [Google Scholar]
  24. 24.
    Li Y, Lopez R, Queener E, et al. 2012.. Adalimumab therapy in Crohn's disease of the ileal pouch. . Inflamm. Bowel Dis. 18::223239
    [Google Scholar]
  25. 25.
    Huguet M, Pereira B, Goutte M, et al. 2018.. Systematic review with meta-analysis: anti-TNF therapy in refractory pouchitis and Crohn's disease–like complications of the pouch after ileal pouch–anal anastomosis following colectomy for ulcerative colitis. . Inflamm. Bowel Dis. 24::26168
    [Google Scholar]
  26. 26.
    Ollech JE, Rubin DT, Glick L, et al. 2019.. Ustekinumab is effective for the treatment of chronic antibiotic-refractory pouchitis. . Dig. Dis. Sci. 64::3596601
    [Google Scholar]
  27. 27.
    Weaver KN, Gregory M, Syal G, et al. 2019.. Ustekinumab is effective for the treatment of Crohn's disease of the pouch in a multicenter cohort. . Inflamm. Bowel Dis. 25::76774
    [Google Scholar]
  28. 28.
    Dalal RS, Gupta S, Goodrick H, et al. 2021.. Outcomes of standard and intensified dosing of ustekinumab for chronic pouch disorders. . Inflamm. Bowel Dis. 28::14649
    [Google Scholar]
  29. 29.
    Travis S, Silverberg MS, Danese S, et al. 2023.. Vedolizumab for the treatment of chronic pouchitis. . N. Engl. J. Med. 388::1191200
    [Google Scholar]
  30. 30.
    Bär F, Kühbacher T, Dietrich NA, et al. 2018.. Vedolizumab in the treatment of chronic, antibiotic-dependent or refractory pouchitis. . Aliment. Pharmacol. Ther. 47::58187
    [Google Scholar]
  31. 31.
    Verstockt B, Claeys C, De Hertogh G, et al. 2019.. Outcome of biological therapies in chronic antibiotic-refractory pouchitis: a retrospective single-centre experience. . United Eur. Gastroenterol. J. 7::121525
    [Google Scholar]
  32. 32.
    Gregory M, Weaver KN, Hoversten P, et al. 2019.. Efficacy of vedolizumab for refractory pouchitis of the ileo-anal pouch: results from a multicenter US cohort. . Inflamm. Bowel Dis. 25::156976
    [Google Scholar]
  33. 33.
    Akiyama S, Cohen NA, Kayal M, et al. 2023.. Treatment of chronic inflammatory pouch conditions with tofacitinib: a case series from 2 tertiary IBD centers in the United States. . Inflamm. Bowel Dis. 29::15047
    [Google Scholar]
  34. 34.
    Ribaldone DG, Testa G, Verstockt B, et al. 2023.. Treatment of antibiotic refractory chronic pouchitis with JAK inhibitors and S1P receptor modulators: an ECCO CONFER multicentre case series. . J. Crohn's Colitis 18::72026
    [Google Scholar]
  35. 35.
    Kayal ML, Lambin T, Pinotti R, et al. 2020.. A systematic review of fecal microbiota transplant for the management of pouchitis. . Crohn's Colitis 360 2::otaa034
    [Google Scholar]
  36. 36.
    Herfarth H, Barnes EL, Long MD, et al. 2019.. Combined endoscopic and oral fecal microbiota transplantation in patients with antibiotic-dependent pouchitis: low clinical efficacy due to low donor microbial engraftment. . Inflamm. Intest. Dis. 4::16
    [Google Scholar]
  37. 37.
    Landy J, Walker AW, Li JV, et al. 2015.. Variable alterations of the microbiota, without metabolic or immunological change, following faecal microbiota transplantation in patients with chronic pouchitis. . Sci. Rep. 5::12955
    [Google Scholar]
  38. 38.
    Selvig D, Piceno Y, Terdiman J, et al. 2020.. Fecal microbiota transplantation in pouchitis: clinical, endoscopic, histologic, and microbiota results from a pilot study. . Dig. Dis. Sci. 65::1099106
    [Google Scholar]
  39. 39.
    Karjalainen EK, Renkonen-Sinisalo L, Satokari R, et al. 2021.. Fecal microbiota transplantation in chronic pouchitis: a randomized, parallel, double-blinded clinical trial. . Inflamm. Bowel Dis. 27::176672
    [Google Scholar]
  40. 40.
    Lu H, Lian L, Navaneethan U, et al. 2010.. Clinical utility of C-reactive protein in patients with ileal pouch anal anastomosis. . Inflamm. Bowel Dis. 16::167884
    [Google Scholar]
/content/journals/10.1146/annurev-med-032224-120544
Loading
  • Article Type: Review Article
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error