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Benefit of antibiotic therapy on pouchitis after ileal pouch anal anastomosis: A systematic review and meta-analysis of clinical trials

  • Research Article
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Central European Journal of Medicine

Abstract

The aim of the study was to evaluate and collect current evidence on the effect of antibiotics in pretreatment of pouchitis after restorative ileal pouch anal anastomosis (IPAA). Pubmed, Embase, Web of Science, Scopus, and Cochrane Library databases were searched between 1966 and July 2008; and relevant clinical trials extracted, reviewed, and validated according to the study protocol. The outcome of interest was clinical improvement after treatment. Nine randomized, placebo-controlled clinical trials were found relevant and studied but 3 of them with 70 patients were entered into meta-analysis. Pooling of the results from these trials yielded an odds ratio of 15.96 with a 95% CI of 4.20–60.70, indicating a significant OR (p<0.0001) in treatment group in comparison to the placebo group. In conclusion, the meta-analysis confirms benefit of antibiotics in management of pouchitis after IPAA operation.

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References

  1. Pricolo V.E., Ileal pouch-anal anastomosis: the ideal operation for ulcerative colitis and adenomatous polyposis coli? R. I. Med., 1994, 77, 382–384

    PubMed  CAS  Google Scholar 

  2. Blumberg D., Beck D.E., Surgery for ulcerative colitis, Gastroenterol. Clin. North Am., 2002, 31, 219–235

    Google Scholar 

  3. Aziz O., Athanasiou T., Fazio V.W., Nicholls R.J., Darzi A.W., Church J., et al., Meta-analysis of observational studies of ileorectal versus ileal pouch-anal anastomosis for familial adenomatous polyposis, Br. J. Surg., 2006, 93, 407–417

    Article  PubMed  CAS  Google Scholar 

  4. Keighley M.R., Review article: the management of pouchitis. Aliment. Pharmacol. Ther., 1996, 10, 449–457

    Article  PubMed  CAS  Google Scholar 

  5. Nicholls R.J., Belliveau P., Neill M., Wilks M., Tabaqchali S., Restorative proctocolectomy with ileal reservoir: a pathophysiological assessment, Gut, 1981, 22, 462–468

    Article  PubMed  CAS  Google Scholar 

  6. Zuccaro G.Jr., Fazio V.W., Church J.M., Lavery I.C., Ruderman W.B., Farmer R.G., Pouch ileitis, Dig. Dis. Sci., 1989, 34, 1505–1510

    Article  PubMed  Google Scholar 

  7. Tytgat G.N., van Deventer S.J., Pouchitis, Int. J. Colorectal Dis., 1988, 3, 226–228

    Article  PubMed  CAS  Google Scholar 

  8. Simchuk E.J., Thirlby R.C., Risk factors and true incidence of pouchitis in patients after ileal pouchanal anastomoses, World J. Surg., 2000, 24, 851–856

    Article  PubMed  CAS  Google Scholar 

  9. Kmiot W.A., Youngs D., Tudor R., Thompson H., Keighley M.R., Mucosal morphology, cell proliferation and faecal bacteriology in acute pouchitis, Br. J. Surg. 1993, 80, 1445–1449

    Article  PubMed  CAS  Google Scholar 

  10. Rahimi R., Nikfar S., Rezaie A., Abdollahi M., A meta-analysis of broad-spectrum antibiotic therapy in patients with active Crohn’s disease, Clin. Ther., 2006, 28, 1983–1988

    Article  PubMed  CAS  Google Scholar 

  11. Rahimi R., Nikfar S., Rezaie A., Abdollahi M., A metaanalysis of antibiotic therapy for active ulcerative colitis, Dig. Dis. Sci., 2007, 52, 2920–2925

    Article  PubMed  CAS  Google Scholar 

  12. Baker D.E., Rifaximin: a nonabsorbed oral antibiotic, Rev. Gastroenterol. Disord., 2005, 5, 19–30

    PubMed  Google Scholar 

  13. Ewaschuk J.B., Tejpar Q.Z., Soo I., Madsen K., Fedorak R.N., The role of antibiotic and probiotic therapies in current and future management of inflammatory bowel disease, Curr. Gastroenterol. Rep., 2006, 8, 486–498

    Article  PubMed  Google Scholar 

  14. Gionchetti P., Rizzello F., Lammers K.M., Morselli C., Sollazzi L., Davies S., et al., Antibiotics and probiotics in treatment of inflammatory bowel disease, World J. Gastroenterol., 2006, 12, 3306–3313

    PubMed  CAS  Google Scholar 

  15. Gionchetti P., Rizzello F., Venturi A., Ugolini F., Rossi M., Brigidi P., et al., Antibiotic treatment in inflammatory bowel disease: rifaximin, a new possible approach, Eur. Rev. Med. Pharmacol. Sci., 1999, 3, 27–30

    PubMed  CAS  Google Scholar 

  16. Sachar D.B., How do you treat refractory pouchitis and when do you decide to remove the pouch? Inflamm. Bowel Dis., 1998, 4, 165–166

    Article  PubMed  CAS  Google Scholar 

  17. Sandborn W.J., McLeod R., Jewell D.P., Medical therapy for induction and maintenance of remission in pouchitis: a systematic review, Inflamm. Bowel Dis. 1999, 5, 33–39

    PubMed  CAS  Google Scholar 

  18. Madden M.V., McIntyre A.S., Nicholls R.J., Doubleblind crossover trial of metronidazole versus placebo in chronic unremitting pouchitis, Dig. Dis. Sci., 1994, 39, 1193–1196

    Article  PubMed  CAS  Google Scholar 

  19. Sambuelli A., Boerr L., Negreira S., Gil A., Camartino G., Huernos S., et al., Budesonide enema in pouchitis-a double-blind, double-dummy, controlled trial, Aliment. Pharmacol. Ther. 2002, 16, 27–34

    Article  PubMed  CAS  Google Scholar 

  20. Shen B., Fazio V., Remzi F., Bennett A., Lopez R., Brzezinski A., et al., Combined ciprofloxacin and tinidazole therapy in the treatment of chronic refractory pouchitis, Dis. Col. Rectum., 2007, 50, 498–508

    Article  Google Scholar 

  21. Isaacs K.L., Sandler R.S., Abreu M., Picco M.F., Hanauer S.B., Bickston S.J., et al., Rifaximin for the treatment of active pouchitis: A randomized, double-blind, placebo-controlled pilot study, Inflamm. Bowel Dis., 2007, 13, 1250–1255

    Article  PubMed  Google Scholar 

  22. Shen B., Achkar J.P., Lashner B.A., Ormsby A.H., Remzi F.H., Brzezinski A., et al., A randomized clinical trial of ciprofloxacin and metronidazole to treat acute pouchitis, Inflamm. Bowel Dis., 2001, 7, 301–305

    Article  PubMed  CAS  Google Scholar 

  23. Nygaard K., Bergan T., Bjorneklett A., Hoverstad T., Lassen J., Aase S., Topical metronidazole treatment in pouchitis, Scand. J. Gastroenterol., 1994, 29, 462–467

    Article  PubMed  CAS  Google Scholar 

  24. Egger M., Smith G.D., Phillips A.N., Meta-analysis: principles and procedures, B. M. J., 1997, 315, 1533–1537

    CAS  Google Scholar 

  25. Abdelrazeq A.S., Kelly S.M., Lund J.N., Leveson S.H., Rifaximin-ciprofloxacin combination therapy is effective in chronic active refractory pouchitis, Colorectal Dis., 2005, 7, 182–186

    Article  PubMed  CAS  Google Scholar 

  26. Abitbol V., Chaussade S., Pouchitis after ileal pouchanal anastomosis. Gastroenterol. Clin. Biol., 1997, 21, 299–304

    PubMed  CAS  Google Scholar 

  27. Becker J.M., Stucchi A.F., Bryant D.E., How do you treat refractory pouchitis and when do you decide to remove the pouch? Inflamm. Bowel Dis., 1998, 4, 167–169

    Article  PubMed  CAS  Google Scholar 

  28. Gerard L., Garey K.W., DuPont H.L., Rifaximin: a nonabsorbable rifamycin antibiotic for use in nonsystemic gastrointestinal infections, Expert. Rev. Anti. Infect. Ther., 2005, 3, 201–211

    Article  PubMed  CAS  Google Scholar 

  29. Gionchetti P., Amadini C., Rizzello F., Venturi A., Poggioli G., Campieri M., Diagnosis and treatment of pouchitis, Best Pract. Res. Clin. Gastroenterol., 2003, 17, 75–87

    Article  PubMed  Google Scholar 

  30. Mimura T., Rizzello F., Helwig U., Poggioli G., Schreiber S., Talbot I.C., et al., Four-week openlabel trial of metronidazole and ciprofloxacin for the treatment of recurrent or refractory pouchitis, Aliment. Pharmacol. Ther., 2002, 16, 909–917

    Article  PubMed  CAS  Google Scholar 

  31. Madiba T.E., Bartolo D.C., Pouchitis following restorative proctocolectomy for ulcerative colitis: incidence and therapeutic outcome. J. R. Coll. Surg. Edinb., 2001, 46, 334–337

    PubMed  CAS  Google Scholar 

  32. Gionchetti P., Rizzello F., Venturi A., Ugolini F., Rossi M., Brigidi P., et al., Antibiotic combination therapy in patients with chronic, treatment-resistant pouchitis, Aliment. Pharmacol. Ther., 1999, 13, 713–718

    Article  PubMed  CAS  Google Scholar 

  33. Shen B., Remzi F.H., Lopez A.R., Queener E., Rifaximin for maintenance therapy in antibioticdependent pouchitis, BMC Gastroenterol., 2008, 23, 26

    Article  Google Scholar 

  34. Gionchetti P., Rizzello F., Helwig U., Venturi A., Lammers K.M., Brigidi P., et al., Prophylaxis of pouchitis onset with probiotic therapy: a doubleblind, placebo-controlled trial, Gastroenterology, 2003, 124, 1202–1209

    Article  PubMed  Google Scholar 

  35. Elahi B., Nikfar S., Derakhshani S., Vafaie M., Abdollahi M., Benefit of probiotics in the control of pouchitis in patients underwent ileal pouch anal anastomosis operation; A meta-analysis of controlled clinical trials, Dig. Dis. Sci., 2007, 53, 1278–1284

    Article  PubMed  Google Scholar 

  36. Sambuelli A., Boerr L., Negreira S., Gil A., Camartino G., Huernos S., et al., Budesonide enema in pouchitis—a double-blind, double-dummy, controlled trial, Aliment. Pharmacol. Ther., 2002, 16, 27–34

    Article  PubMed  CAS  Google Scholar 

  37. Gionchetti P., Rizzello F., Venturi A., Ferretti M., Brignola C., Peruzzo S., et al., Long-term efficacy of bismuth carbomer enemas in patients with treatment-resistant chronic pouchitis, Aliment. Pharmacol. Ther., 1997, 11, 673–678

    Article  PubMed  CAS  Google Scholar 

  38. Wischmeyer P., Pemberton J.H., Phillips S.F., Chronic pouchitis after ileal pouch-anal anastomosis: responses to butyrate and glutamine suppositories in a pilot study, Mayo Clin. Proc., 1993, 68, 978–981

    PubMed  CAS  Google Scholar 

  39. Levin K.E., Pemberton J.H., Phillips S.F., Zinsmeister A.R., Pezim M.E., Role of oxygen free radicals in the etiology of pouchitis. Dis. Colon Rectum, 1992, 35, 452–456

    Article  PubMed  CAS  Google Scholar 

  40. Hurst R.D., Molinari M., Chung T.P., Rubin M., Michelassi F., Prospective study of the incidence, timing and treatment of pouchitis in 104 consecutive patients after restorative proctocolectomy, Arch. Surg., 1996, 131, 497–500

    PubMed  CAS  Google Scholar 

  41. Rahimi R., Nikfar S., Rezaie A., Abdollahi M., A metaanalysis of the benefit of probiotics in maintaining remission of human ulcerative colitis: evidence for prevention of disease relapse and maintenance of remission, Arch. Med. Sci. 2008, 4, 185–190

    Google Scholar 

  42. Rahimi R., Nikfar S., Rahimi F., Elahi B., Derakhshani S., Vafaie M., et al., A meta-analysis on the efficacy of probiotics for maintenance of remission and prevention of clinical and endoscopic relapse in Crohn’s disease, Dig. Dis. Sci., 2008, 53, 2524–2531

    Article  PubMed  Google Scholar 

  43. Nikfar S., Rahimi R., Rahimi F., Derakhshani S., Abdollahi M., Efficacy of probiotics in irritable bowel syndrome: a meta-analysis of randomized, controlled trials, Dis. Col. Rectum, 2008, 51, 1775–1780

    Article  Google Scholar 

  44. Fric P., Probiotics and prebiotics; resistance of a therapeutic principle, Cent. Eur. J. Med., 2007, 2, 237–270.

    Article  Google Scholar 

  45. Rahimi R., Nikfar S., Abdollahi M., Selective serotonin reuptake inhibitors for the management of irritable bowel syndrome: A meta-analysis of randomized controlled trials, Arch. Med. Sci., 2008, 4, 71–76

    CAS  Google Scholar 

  46. Talley N.J., Newer antidepressants in irritable bowel syndrome: what is the evidence? Arch. Med. Sci., 2008, 4, 77–78.

    Google Scholar 

  47. Rahimi R., Nikfar S., Abdollahi M., Meta-analysis technique confirms the effectiveness of anti-TNF-a in the management of active ulcerative colitis when administered in combination with corticosteroids, Med. Sci. Monit., 2007, 13, PI13–PI18

    PubMed  CAS  Google Scholar 

  48. Rahimi, R., Nikfar, S., Abdollahi M., Do anti-tumor necrosis factors induce response and remission in patients with acute refractory Crohn’s disease? A systematic meta-analysis of controlled clinical trials, Biomed. Pharmacother., 2007, 61, 75–80

    Article  PubMed  CAS  Google Scholar 

  49. Hosseini-Tabatabaei A., Abdollahi M., Potassium channel openers and improvement of toxic stress: do they have role in the management of inflammatory bowel disease? Inflamm. Allergy Drug Targets, 2008, 7, 129–135

    Article  PubMed  CAS  Google Scholar 

  50. Rezaie A., Parker R.D., Abdollahi M., Oxidative stress and pathogenesis of inflammatory bowel disease: an epiphenomenon or the cause? Dig. Dis. Sci., 2007, 52, 2015–2021

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Division of Neurology, Institute of Medical Sciences, University of Toronto, Toronto, M5S 1A8, Canada

    Behzad Elahi

  2. Food and Drug Affairs, and Food & Drug Laboratory Research Center, Ministry of Health & Medical Education, Tehran, 1314715311, Iran

    Shekoufeh Nikfar

  3. Baharan Coloproctology Surgical Clinic, Tehran, 1516633115, Iran

    Saeed Derakhshani & Mohammad Vafaie

  4. Faculty of Pharmacy, and Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, 1417614411, Iran

    Mohammad Abdollahi

Authors
  1. Behzad Elahi
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  2. Shekoufeh Nikfar
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  3. Saeed Derakhshani
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  4. Mohammad Vafaie
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  5. Mohammad Abdollahi
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Correspondence to Mohammad Abdollahi.

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Elahi, B., Nikfar, S., Derakhshani, S. et al. Benefit of antibiotic therapy on pouchitis after ileal pouch anal anastomosis: A systematic review and meta-analysis of clinical trials. cent.eur.j.med 4, 164–170 (2009). https://doi.org/10.2478/s11536-009-0019-4

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  • DOI: https://doi.org/10.2478/s11536-009-0019-4

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