Pouchitis is a relatively common condition and has been shown to occur in 30%-60% of patients following total proctocolectomy with ileo-anal anastomosis (commonly known as a J-pouch), where the patients were followed for one year. This procedure removes the entire colon and rectum while preserving the anal sphincter and, hence, normal bowel function and faecal continence. The pouch serves as an internal pelvic reservoir for intestinal contents. This surgery is the preferred surgical intervention for ulcerative colitis,
Patients with pouchitis frequently present with bloody diarrhoea, urgency, and dehydration as well as endoscopic evidence of erythema of the mucosal pouch, (Erythematous mucosa is inflammation of the mucosal lining of the digestive tract).
The causes of this condition have yet to be proven, but it is thought that it could be caused by toxins liberated during bacterial degradation, changes in intraluminal pH (the acidity in the gut) and shifts in the microbiome.
Current standard therapies that block immune activation with oral immunosuppressives and/or biologic agents are generally effective, but each therapy induces sustained remission in only a minority of patients and necessitates long term treatments. Indeed, earlier studies report that the use of antibiotics only provided short term relief and 95% of patients reported recurring symptoms after such treatment.
SBI has a multifaceted mechanism of action to help maintain and support barrier function within the gastrointestinal tract. One of these facets is that it will bind to microbial components (i.e., bacterial toxins) which may result in the reduction of downstream inflammatory markers and tight junction restoration.
For this study, ten patients, aged between 24 and 69 years old were chosen. These patients had failed to achieve any remission in their condition after conventional treatments, as listed above.
Maintenance therapy was introduced of SBI (5g QD or BID) and this has allowed 8 out of 10 patients to continue remission for more than 1 year while another patient has been in remission for nearly 9 months. Additionally, the use of SBI has allowed 7 out of 10 patients to eliminate the need for some or all other therapies as part of the ongoing management of their pouchitis. Only a single patient had not experienced remission, although the patient did experience improvement in stool frequency.
The researchers concluded that a comprehensive study would be useful to demonstrate if SBI should be a part of a therapeutic approach for pouchitis and if it would help facilitate and maintain remission. Additionally, it should be ascertained whether this therapy would assist to achieve an earlier response to pouchitis flares in sufferers.