Pouchitis
- Pouchitis is an inflammatory condition of the ileal pouch reservoir of an ileal pouch-anal anastomosis or ileostomy.
- Symptoms include: increase in stool frequency, tenesmus, change in stool consistency, abdominal cramps and rectal bleeding.
- Endoscopy (pouchoscopy) is the main tool in the diagnosis of pouchitis.
- Faecal PCR and C.diff toxin should also be performed before initiating antibiotics
Acute Pouchitis
- Acute pouchitis symptoms are for less than 4 weeks
- Always consult gastroenterology team.
- Ideally perform endoscopy prior to treatment
Preferred
ciprofloxacin* 500mg po bd for 14 days
Ensure that the patient is given the Fluoroquinolone MHRA patient information leaflet. Fluoroquinolones, including ciprofloxacin are associated with disabling and potentially long-lasting or irreversible side effects. See Fluoroquinolone antibiotics - severe adverse effects.
Alternative - For patients at high-risk of adverse events or are unable to tolerate fluoroquinolones
metronidazole 400mg po tds for 14 days
Chronic Pouchitis
- Chronic pouchitis symptoms are for 4 weeks or more or are recurrent
- Ideally perform faeces culture, faecal PCR and/or endoscopy prior to treatment
Preferred
ciprofloxacin* 500mg po bd AND metronidazole 400mg po bd for 14 days
If the 14-day combination course fails, consult gastroenterology team for further treatment options.
Ensure that the patient is given the Fluoroquinolone MHRA patient information leaflet. Fluoroquinolones, including ciprofloxacin are associated with disabling and potentially long-lasting or irreversible side effects. See Fluoroquinolone antibiotics - severe adverse effects.
References
- The British Society of Gastroenterology. BSG consensus guidelines on the Management of Inflammatory Bowel Disease in Adults. Available at bsg.org.uk/clinical-resource/bsg-consensus-ibd-guidelines. Accessed July 2024