Diversion colitis and pouchitis: A mini-review

Table 3 Summary of pharmacologic treatments

Treatment	Ref.	Procedure/standard dosage	Efficacy	Complications/main side effects
Surgical anastomosis	[2,3,10,21,25,39,42]	Mobilization of both ends of the bowel with either sutured or stapled anastomosis.	The most effective method of eliminating the signs and symptoms	Bleeding, infection, anastomotic leak, anastomotic stricture, anesthetic risks
Corticosteroids	[2,32,33]	Hydrocortisone (100 mg per 60 mL bottle) enema is administered once daily for up to 3 wk.	Response to treatment is generally seen in 3 to 5 d.	Local pain and burning, occasionally rectal bleeding.
		Occasional treatment may be given for 2 to 3 mo depending on clinical response.		Prolonged treatment may result in systemic absorption, causing systemic side effects.
5-aminosalicylic acid (5-ASA) enemas	[31,43,63,64]	4 g of mesalazine in 60 mL suspensions, administered rectally once-daily dose for 4 to 5 wk.	Varying effect	Occasionally produces acute intolerance manifested by cramping, acute abdominal pain, bloody diarrhea, fever, headache, and rash.
Short-chain-fatty acid (SCFA)	[5,10,13,18,19,26,27,61,62]	SCFA enema rectally twice a day for 2 wk, and then tapered according to response over 2 to 4 wk.	Varying effect	None
Irrigation with Fibers	[65,66]	Solution containing 5% fibers (10 g/d) for 7 d.	The endoscopic score which is used to quantify the intensity of the inflammation at the mucosa at the diverted colon diminished after treatment.	Probably none
Leukocytapheresis	[44]	Leukocytapheresis, at flow rate of 40 mL/min for 60 min, once weekly for 5 wk, following low dose of metronidazole and ciprofloxacin, another set of weekly leukocytapheresis was added.	Significant improvement in her pouchitis disease activity index (PDAI) from 14 to 1.	The common side effects were nausea, vomiting, fever, chills, and nasal obstruction.
Autologous fecal transplantation	[45]	Feces were collected from the colostomy bag, diluted with 600 ml of sterile saline (0.9 %), stirred and filtered three times using an ordinary coffee filter, irrigation endoscopically. This procedure was repeated 3 times within 4 wk (on day 0, day 10 and day 28).	All symptoms improved dramatically within 5 d after the first treatment. Colonoscopy 28 d after the first treatment showed no major signs of inflammation in the colonic stump	None, patient's tolerance required.
Dextrose spray (hypertonic glucose)	[29]	Endoscopically sprayed with 150 mL 50% dextrose via a catheter.	Follow-up pouchoscopy 2 wk after the dextrose spray showed normal pouch mucosa with no evidence of bleeding or mucosal friability.	It has a very low chance of causing transient hyperglycemia because there is no direct injection of the hypertonic solution into blood vessels.

SCFA: Short chain fatty acids; 5-ASA: 5-aminosalicylic acid.