RESUMO
Pouchitis treatment is a complex entity that requires a close medical and surgical relationship. The elective treatment for acute pouchitis is antibiotics. After a first episode of pouchitis it is recommended prophylaxis therapy with a probiotic mix, nevertheless it is not clear the use of this formulation for preventing a first episode of pouchitis after surgery. First-line treatment for chronic pouchitis is an antibiotic combination. The next step in treatment should be oral budesonide. Selected cases of severe, chronic refractory pouchitis may benefit from biologic agents, and anti-TNF α should be recommended as the first option, leaving the new biologicals for multi-refractory patients. Permanent ileostomy may be an option in severe refractory cases to medical treatment.
Assuntos
Antibacterianos/uso terapêutico , Colite Ulcerativa/cirurgia , Complicações Pós-Operatórias/terapia , Pouchite/terapia , Probióticos/uso terapêutico , Doença Aguda , Comitês Consultivos , Algoritmos , Produtos Biológicos/uso terapêutico , Budesonida/uso terapêutico , Doença Crônica , Ciprofloxacina/uso terapêutico , Doença de Crohn , Resistência a Medicamentos , Enema/métodos , Humanos , Ileostomia/métodos , Imunossupressores/uso terapêutico , Metronidazol/uso terapêutico , Complicações Pós-Operatórias/prevenção & controle , Pouchite/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Prevenção Secundária/métodos , EspanhaRESUMO
Pouchitis is a common complication in ulcerative colitis patients after total proctocolectomy. This is an unspecific inflammation of the ileo-anal pouch, the aetiology of which is not fully known. This inflammation induces the onset of symptoms such as urgency, diarrhoea, rectal bleeding and abdominal pain. Many patients suffering from pouchitis have a lower quality of life. In addition to symptoms, an endoscopy with biopsies is mandatory in order to establish a definite diagnosis. The recommended index to assess its activity is the Pouchitis Disease Activity Index (PDAI), but its modified version (PDAIm) can be used in clinical practice. In accordance with the duration of symptoms, pouchitis can be classified as acute (<4 weeks) or chronic (>4 weeks), and, regarding its course, pouchitis can be infrequent (<4 episodes per year), recurrent (>4 episodes per year) or continuous.
Assuntos
Colite Ulcerativa/complicações , Consenso , Pouchite/diagnóstico , Pouchite/epidemiologia , Doença Aguda , Doença Crônica , Colite Ulcerativa/cirurgia , Bolsas Cólicas , Diagnóstico Diferencial , Humanos , Incidência , Mucosa Intestinal , Isquemia/complicações , Complicações Pós-Operatórias , Pouchite/classificação , Pouchite/etiologia , Proctocolectomia Restauradora , Prognóstico , Qualidade de Vida , Fatores de Risco , Índice de Gravidade de DoençaAssuntos
Adalimumab/efeitos adversos , Corticosteroides/efeitos adversos , Anti-Inflamatórios/efeitos adversos , Doença de Crohn/tratamento farmacológico , Imunossupressores/efeitos adversos , Infecções Oportunistas/etiologia , Aspergilose Pulmonar/etiologia , Adalimumab/uso terapêutico , Corticosteroides/uso terapêutico , Adulto , Anti-Inflamatórios/uso terapêutico , Antifúngicos/uso terapêutico , Cilastatina/uso terapêutico , Doença de Crohn/complicações , Diagnóstico Diferencial , Suscetibilidade a Doenças , Humanos , Imipenem/uso terapêutico , Hospedeiro Imunocomprometido , Imunossupressores/uso terapêutico , Masculino , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/tratamento farmacológico , Aspergilose Pulmonar/diagnóstico , Aspergilose Pulmonar/tratamento farmacológico , Tomografia Computadorizada por Raios X , Tuberculose Pulmonar/diagnósticoRESUMO
Vedolizumab (VDZ), a human monoclonal antibody that binds specifically to α4ß7-integrin, and is approved for the treatment of Crohn's disease (CD) and ulcerative colitis (UC), has demonstrated its efficacy in controlled clinical trials. OBJECTIVE: To describe a population treated with VDZ and to evaluate its long-term efficacy and safety in clinical practice. METHODS: An observational and multicentre study was carried out on patients with inflammatory bowel disease treated with VDZ for at least one year. An evaluation was performed on the activity indices, faecal calprotectin and C-reactive protein levels, hospital admissions, surgeries, and adverse events. RESULTS: A total of 73 patients were analysed (43 UC and 30 CD). More than one anti-TNF and more than one immunosuppressive was previously used by 74 and 23%, respectively, of UC patients, and 90 and 37%, respectively of CD patients. VDZ was stopped in 17 (23%) patients, 10 UC and 7 CD, due to a lack or loss of response before the first year, or due to adverse events. An intensification of the dose was required in 26 (63%) UC, and 16 (53%) CD patients. At 6 months, 70 and 42% of UC patients, and 80 and 43% of CD patients achieved a clinical response and remission, respectively. At one year, 58 and 35% of UC patients and 47 and 43% of CD patients, maintained the clinical response and remission, respectively. The C-reactive protein decreased significantly in both CD and UC patients. However, the decrease in faecal calprotectin was only achieved during follow-up in UC, but not in CD patients. Eight patients with CD that had been treated previously with ustekinumab avoided surgery at one year. A colectomy was performed on 8 (18.6%) UC patients, and 4 (13.3%) CD patients needed surgery. Six patients (8%) (5 UC and 1 CD) had adverse events. The concomitant use of corticosteroids or immunomodulators did not increase the efficacy. Those with a higher number of previous anti-TNF treatments showed less remissions in UC and responses in CD. CONCLUSIONS: After one year of VDZ, a clinical response and remission was induced in a considerable percentage of patients refractory to different biological or immunosuppressive therapies. VDZ can be considered as an alternative in those intolerant to immunosuppressives, with few adverse events.