Published online Aug 26, 2019. doi: 10.12998/wjcc.v7.i16.2316
Peer-review started: May 8, 2019
First decision: May 31, 2019
Revised: June 18, 2019
Accepted: July 20, 2019
Article in press: July 20, 2019
Published online: August 26, 2019
Processing time: 124 Days and 6.2 Hours
Refractory pouchitis is a common cause of pouch failure, which may require surgical excision of the pouch or permanent diversion. We aimed to show the effect of vedolizumab on treatment of the patient with refractory pouchitis.
A 32-year-old male with pancolonic ulcerative colitis since the age of 25 with primary failure of infliximab and mesalamine and intolerance of azathioprine, underwent a total proctocolectomy with ileal pouch-anal anastomosis in 2012. He developed chronic diarrhea in 2014, which was watery, 30 per day and accompanied with blood and mucus affecting his quality of life.
Vedolizumab is safe and effective in the management of anti-tumor necrosis factor alpha refractory pouchitis.
Core tip: Vedolizumab, a humanized immunoglobulin G1 monoclonal antibody to α4β7 integrin, has been shown to moderate gut lymphocyte trafficking with an efficacy in treatment of both Crohn’s disease and ulcerative colitis. In our patient who had two different anti-tumor necrosis factor refractory pouchitis, the gut-specific immune modulation mediated by vedolizumab treatment resulted in good responses. This case is important because vedolizumab is the novel therapy for refractory pouchitis. However, further large and prospective studies are needed for efficacy and the underlying mechanisms of efficacy of vedolizumab in treatment of refractory pouchitis.