# Key Focus Areas in Pouchitis Therapeutic Status: A Narrative Review

## TL;DR

This review discusses the current state of pouchitis treatment, highlighting diagnostic criteria and various therapeutic approaches to address this common complication after surgery.

## Contribution

The paper provides a comprehensive overview of both conventional and emerging therapies for pouchitis, emphasizing the need for further research.

## Key findings

- Diagnostic criteria include symptoms, endoscopic findings, and fecal calprotectin tests.
- Antibiotics and probiotics are conventional treatments, while newer therapies like anti-TNF agents and fecal microbiota transplantation are also discussed.
- Dietary changes and complementary medicines can influence treatment outcomes.

## Abstract

Pouchitis, as the most common complication after ileal pouch-anal anastomosis (IPAA), has an incidence from 7% to 46%. Pouchitis treatment still represents one of the biggest gaps of knowledge in the treatment of diseases. This review has focused on achievements and challenges in the treatment of pouchitis. A combined assessment of symptoms, endoscopic findings, histologic results, quick biomarkers, and fecal calprotectin test were determined to be valuable diagnostic criteria. Conventional therapy was described as a modification of bacterial flora, mainly with antibiotics and more recently with probiotics such as bifidobacteria, lactobacilli, and streptococci. Other therapeutic approaches such as anti-tumor necrosis factor, infliximab, adalimumab, vedolizumab, ustekinumab, tacrolimus, tofacitinib, thiopurines, corticosteroids, prolyl hydroxylase–containing enzymes, povidone-iodine, dextrose spray, fecal microbiota transplantation, herbal medicines, and leukocyte apheresis have been discussed. Changes in dietary components, and administration of complementary and alternative medicine, probiotics, and fecal transplantation in addition to conventional therapies were also shown to affect the outcome of disease. Due to the potential significant impairment in quality of life caused by pouchitis, it is essential to address the gaps in knowledge for both patients and physicians in its treatment. Therefore, well-designed and adequately powered studies should assess the optimal treatment for pouchitis.