Evidence-Based Approach to Chronic Antibiotic Refractory Pouchitis: A Review

Area of Science:

• Gastroenterology
• Inflammatory Bowel Disease
• Surgical Outcomes

Background:

• Chronic antibiotic refractory pouchitis (CARP) poses a significant therapeutic challenge following restorative proctocolectomy with IPAA.
• CARP is defined by persistent pouchitis symptoms unresponsive to standard antibiotic treatments.

Purpose of the Study:

• To provide a comprehensive narrative review of current evidence on managing CARP.
• To summarize the efficacy and limitations of various therapeutic interventions for CARP.

Main Methods:

• Systematic literature search of PubMed for studies on CARP management.
• Inclusion of case series, cohort studies, RCTs, and meta-analyses published within the last 3-5 years.
• Evaluation of both pharmacologic and select non-pharmacologic interventions.

Main Results:

• Mesalamine offers symptom relief but not quality of life improvement.
• Budesonide shows high remission rates in small patient groups.
• Anti-TNF therapies and vedolizumab demonstrate efficacy in clinical and endoscopic outcomes.
• Ustekinumab shows encouraging clinical response.
• Hyperbaric oxygen and fecal microbiota transplant have limited data and accessibility concerns.

Conclusions:

• Biologic therapies are effective, steroid-sparing options for refractory CARP.
• Further research is needed for non-pharmacologic therapies like hyperbaric oxygen and fecal microbiota transplant.
• Current evidence is largely based on small, retrospective studies, highlighting a need for larger trials.