Pouchitis,作为回肠袋-肛门吻合术(IPAA)后最常见的并发症,发病率从7%到46%。囊炎治疗仍然是疾病治疗中最大的知识空白之一。本文主要综述了囊炎治疗方面的成就和挑战。对症状的综合评估,内镜检查结果,组织学结果,快速生物标志物,和粪便钙卫蛋白试验被确定为有价值的诊断标准。常规疗法被描述为细菌菌群的修饰,主要使用抗生素,最近使用益生菌,如双歧杆菌,乳酸杆菌,和链球菌.其他治疗方法,如抗肿瘤坏死因子,英夫利昔单抗,阿达木单抗,维多珠单抗,ustekinumab,他克莫司,托法替尼,硫嘌呤,皮质类固醇,含脯氨酸羟化酶的酶,聚维酮碘,葡萄糖喷雾剂,粪便微生物移植,草药,和白细胞单采术已经讨论过了。饮食成分的变化,以及补充和替代医学的管理,益生菌,除常规疗法外,粪便移植也会影响疾病的结局。由于囊炎可能对生活质量造成严重损害,必须解决患者和医生在治疗方面的知识差距。因此,精心设计和足够有力的研究应评估囊炎的最佳治疗方法.
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.