A 22-year-old female presented to our department reporting a new on a series of episodes of pouchitis. Restorative proctocolectomy with ileal pouch-anal anastomosis had become necessary 7 years previously as a result of severe refractory extensive ulcerative colitis. She was first diagnosed with pouchitis 1 year after surgery and had been suffering from recurrent episodes since that time. Initially she was taking antibiotics and prednisolone (for more severe episodes) but since it was a case of chronic refractory disease the treating physicians at that time decided to administer infliximab followed by adalimumab, both of which she discontinued after an early severe allergic reaction and a loss of response attributed to antibody formation, respectively. During the last year she had managed several relapses using antibiotics and prednisolone. Laboratory tests on admission showed white blood cells 12,500/mm³, hemoglobin 10.3 g/dL, erythrocyte sedimentation rate 58 mm/h, and C-reactive protein 5.47 mg/dL. A pouchoscopy revealed multiple ulcers, edema, loss of vascular pattern and the presence of fistulas (Fig. 1A). The Pouchitis Disease Activity Index (PDAI) endoscopic subscore was 6 and the histology was compatible with chronic pouchitis. Vedolizumab was subsequently initiated, together with a single course of antibiotics, and the patient experienced improvement in clinical symptoms and laboratory results with no documented relapse since then. A new pouchoscopy at week 33 showed significant improvement (Fig. 1B), with scars and small ulcerations (PDAI endoscopic subscore 2).
Figure 1.
Endoscopic appearance of pouch (A) before vedolizumab treatment and (B) after 33 weeks of treatment with vedolizumab
This impressive endoscopic improvement highlights the emerging role of vedolizumab as a treatment option for chronic, antibiotic-dependent or refractory pouchitis, validating the existing case series and reports [1-3].
Biography
University Hospital of Heraklion, Crete, Greece
Footnotes
Conflict of Interest: None
References
- 1.Bär F, Kühbacher T, Dietrich NA, et al. German IBD Study Group. Vedolizumab in the treatment of chronic, antibiotic-dependent or refractory pouchitis. Aliment Pharmacol Ther. 2018;47:581–587. doi: 10.1111/apt.14479. [DOI] [PubMed] [Google Scholar]
- 2.Philpott J, Ashburn J, Shen B. Efficacy of vedolizumab in patients with antibiotic and anti-tumor necrosis alpha refractory pouchitis. Inflamm Bowel Dis. 2017;23:E5–E6. doi: 10.1097/MIB.0000000000000992. [DOI] [PubMed] [Google Scholar]
- 3.Coletta M, Paroni M, Caprioli F. Successful treatment with vedolizumab in a patient with chronic refractory pouchitis and primary sclerosing cholangitis. J Crohns Colitis. 2017;11:1507–1508. doi: 10.1093/ecco-jcc/jjx090. [DOI] [PubMed] [Google Scholar]