Pouchitis is an inflammation of the lining of an internal pouch (small bowel pocket) created in ulcerative colitis sufferers to hold bowel movements after they have had part of their colon and rectum removed to treat their disorder. There are two types of pouches, the ileoanal (pull-through) pouch and the continent ileostomy (Koch) pouch, which surgeons create using part of the patient's small intestine. Both types of pouches spare patients from having to use an external colostomy bag to hold waste.
When the lining of these internal pouches become inflamed, it can cause symptoms similar to ulcerative colitis, including diarrhea, abdominal pain, bleeding, fever, joint pain and dehydration. Approximately 32 percent of ulcerative colitis patients who get an ileonanal pouch following removal of their colon will develop pouchitis. The longer patients have their pouch, the greater their risk for developing the problem. Smokers and patients with other health problems, such as immunologic skin disease, severe inflammatory joint disease, such as arthritis, or a history of primary sclerosing cholangitis (a disease of the bile ducts) are at greater risk for developing pouchitis.
A diagnosis of pouchitis is made based on a combination of examinations, including endoscopies to look inside the pouch, X-rays to rule out Crohn's disease or other disorders and a tissue biopsy of the pouch. Most patients with pouchitis respond to treatment with antibiotics, including metronidazole and ciprofloxacin, although about two-thirds of patients will suffer recurrences.
Because researchers have found that people with pouchitis have fewer beneficial bacteria, such as lactobacilli and bifidobacteria, in their digestive tract than healthy people, scientists are studying the potential benefit of getting probiotic (live bacteria) therapy either in supplements or through food to lessen the symptoms of pouchitis and keep it from recurring and there is some evidence showing that probiotics may be helpful for some sufferers.
If you're at risk for developing pouchitis, talk to your doctor about the best course of action for you and whether probiotics can help. Keep in mind:
- Probiotic therapy has not been proven helpful in treating acute, severe pouchitis
- Probiotics may be helpful in delaying onset of pourchitis or in maintaining remission after being treated with antibiotics
- More studies need to be done to determine the role of probiotics in the treatment of pouchitis
And remember, even people who develop pouchitis find that their quality of life is better than when they had ulcerative colitis.
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