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Probiotics for Pouchitis

What is pouchitis?


Pouchitis is an inflammation that occurs in the pouch’s lining during ulcerative colitis surgery. It’s the most common long-term complication of j-pouch (ileal pouch-anal anastomosis or IPAA) a surgery for ulcerative colitis.


What are the causes of pouchitis?


The cause of pouchitis is not entirely clear. However, studies suggest that there is an abnormal immune response to the pouch microflora. People with pouchitis have more aggressive bacteria than protective ones. These imbalances may play a role in the development of inflammation of the pouch. The inflammation may also result from microbial imbalance, bacterial overgrowth, and unstable microflora. Other factors associated with the development of pouchitis include:

  • Being a smoker
  • Inflammation of the ileum due to widespread ulcerative colitis
  • Diabetes
  • Heart diseases
  • Use of NSAIDs for a prolonged time
  • The presence of antibodies in the blood


What are the symptoms of pouchitis?


Symptoms of pouchitis include:

  • Rectal bleeding
  • Fever
  • Abdominal cramping
  • Urgent and more frequent bowel movement
  • Tail bone pain
  • Straining during defecation
  • Painful spasm
  • Discomfort in the pelvic area or lower abdomen

In severe cases, symptoms may include:

  • Dehydration
  • Fever
  • Fatigue
  • Severe joint pain
  • Iron deficiency anemia


Pouchitis treatment


Getting treatment for pouchitis, especially following ileal surgery is very important. Typically, people with this condition respond well to conventional treatment such as antibiotics. However, less than 10% who experienced pouchitis does not respond to antibiotics.

For some patients, low carbohydrate and/or low-fiber and high protein may help relieve the symptoms. Taking anti-diarrhea medications may also help treat loose or frequent bowel movements.


How would probiotics help with pouchitis?


In a recent study, the medical experts discovered that people pouchitis have fewer beneficial bacteria in their GI tract. The evidence strongly suggests that increasing the number of beneficial bacteria with probiotics would help improve the symptoms of pouchitis and remission of pouchitis.


Probiotics are live beneficial microbes, especially good for the digestive system. They are a natural treatment for many inflammatory diseases that affect the GI tract. For pouchitis, probiotics have received much attention as a means of altering the pouch flora. The use of probiotics has shown promising results in inducing remission (complete, sustained reduction of symptoms).


Although the primary treatment is a 14-day course of antibiotics, doctors recommend a combination of 8 strains of probiotics after the antibiotic therapy. These strains include:

  • acidophilus
  • plantarum
  • paracasei
  • delbrueckii
  • longum
  • breve
  • infantis
  • Thermophilus


The use of probiotics in treating severe and acute pouchitis has not yet been proven, but it may be helpful in the prevention of recurrent pouchitis after antibiotic therapy. The use of probiotics in combination with other treatments may help prevent a flare-up of pouchitis.

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