Oral vancomycin may be effective for pouchitis in inflammatory bowel disease

1. In patients with pouchitis associated with inflammatory bowel disease (IBD) and primary sclerosing cholangitis (PSC), the use of oral vancomycin was associated with endoscopic and clinical improvements characterized by reduced stool frequency, urgency and incontinence.

Evidence Rating Level: 2 (Good)

Pouchitis is a common complication among patients with ileal pouch-anal anastomosis (IPAA) which is commonly required among individuals with IBD-associated PSC. PSC-associated pouchitis (PSC-pouchitis) is a complex and distinct condition lacking standardized guidelines, as it is usually refractory to traditional antibiotic therapy. This retrospective cohort study therefore sought to investigate the clinical and endoscopic outcomes associated with the use of oral vancomycin in patients with PSC-pouchitis. 48 patients with PSC-pouchitis (median age at PSC diagnosis[IQR], 29.7[22.8-39.7] years; 77.1% male) from a tertiary centre in the United States were included in this study. The primary outcome was symptom improvement as defined by a decrease in symptom subscore of the modified Pouch Disease Activity Index (mPDAI) by ≥1 point. Symptomatic improvement occurred in 89.5% of patients (43/48) with a mean change in mPDAI symptom subscore of 2 (IQR, 2-3). Endoscopic improvement occurred in 65% of patients (26/48) with a mean change in mPDAI endoscopic subscore of 2 (IQR, 1-4). Observed clinical outcomes included a decrease in stool frequency from 10.0 (IQR 8.0, 13.2) to 6.0 (IQR 5.0, 7.0) (P-value < .001), a decrease in fecal urgency from 72.9% to 12.5% (P-value < .001) and improvement in fecal incontinence from 33.3% to 4.2% (P-value < .001). Overall, this study found that among patients with PSC-pouchitis, the use of oral vancomycin was associated with endoscopic and clinical improvements. 

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