Editing Pouchitis (section)

== Management ==

* Treatment goals
** Alleviate symptoms
** Improve quality of life
** Achieve clinical and      endoscopic remission by demonstrating mucosal healing
* Primary prevention
** Minimise NSAIDs
** Maintain healthy weight
* Acute idiopathic pouchitis
** Avoid NSAIDs
** Diet low in poorly digested      carbohydrates and fibre (although there are variable recommendations…      refer to dietician with expertise)
** Oral antibiotic for two      weeks (ciprofloxacin 500mg BD, or metronidazole 500mg BD). If no      response, culture the stool and give four weeks of antibiotics based on      susceptibility.
** Pouch lavage?
* Relapsed acute pouchitis
** PO Abx
** Consider maintenance therapy      for those with frequent relapses
* Chronic pouchitis
** Probiotic
* CARP
** Screen for PSC, IgG4      disease, or other secondary cause
** Trial topical mesalamine for      four weeks
** If effective, basically      manage as UC
** Biologics are available for      refractory cases