Diagnosis and treatment of pouchitis

Total proctocolectomy with ileal pouch-anal anastomosis is the surgical procedure of choice for the management of ulcerative colitis. Pouchitis, a non-specific inflammation of the ileal reservoir, is the most frequent complication that patients experience in the long-term. Diagnosis should.: be made on the basis of.clinical, endoscopic and histological aspects. The Pouchitis Disease Activity Index (PDAI) represents-an, objective and reproducible scoring system for pouchitis: active pouchitis is defined] as a score greater than or equal to 7 and remission as a score < 7. About 15% of patients develop a chronic disease. Treatment, of pouchitis is empirical, and very few controlled studies have been carried out. Antibiotics, particularly metronidazole and may benefit from a ciprofloxacin, are the treatment of choice. Chronic prolonged course of a combination of antibiotics. Highly concentrated probiotics are effective for both prevention of: relapses and prevention of pouchitis onset. There is no convincing evidence of the efficacy of other therapeutic agents.