Oral vancomycin in the treatment of primary sclerosing cholangitis-associated pouchitis
Bo Shen
Abstract
Pouchitis is a common complication in those with restorative proctocolectomy with ileal pouch–anal anastomosis (IPAA). Some patients may develop chronic antibiotic-refractory pouchitis and its management can be challenging. Primary sclerosing cholangitis (PSC) has consistently been reported to be a risk factor for chronic pouchitis. Patients with PSC-associated pouchitis and enteritis may represent a unique phenotype [1] that usually does not respond to conventional antibiotics, such as metronidazole and ciprofloxacin. PSC-associated pouchitis has been treated with budesonide [2]. Vancomycin has been explored in the treatment of PSC [3], while the agent is routinely used for the treatment of Clostridium difficile-associated pouchitis [4].