Treatment of acute pouchitis

Acute pouchitis is a common disease that affects many patients with an ileal pouch-anal anastomosis. The management of acute pouchitis remains largely empiric with the mainstay of therapy being the antibiotics ciprofloxacin and metronidazole. Probiotics may have a role in the primary and secondary prophylaxis of acute pouchitis. In addition, there are modest data that probiotics are effective in the treatment of mild acute pouchitis. There are limited data for other treatments of acute pouchitis including oral and rectal budesonide and glutamine suppositories. Diet plays a largely undefined role in the development and management of acute pouchitis, and, although many have been studied, no specific diet can currently be recommended. Larger well-designed clinical trials are necessary to confirm the efficacy of current treatments and to investigate new treatments for the management of acute pouchitis.