Two years after restorative proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis, a 34-year-old woman reports increased stool frequency up to ten per day, urgency, nocturnal seepage, and watery stools. Endoscopy of the pouch shows granular, friable mucosa and histology confirms acute inflammation. What is the first-line treatment?
- A Oral mesalazine
- B A two-week course of oral ciprofloxacin or metronidazole ✓
- C Oral prednisolone taper
- D Pouch excision with permanent end ileostomy
Correct answer: B. A two-week course of oral ciprofloxacin or metronidazole
Explanation
Idiopathic pouchitis affects up to half of patients within ten years of ileal pouch-anal anastomosis and presents exactly as described. First-line therapy is a two-week course of an antibiotic, classically metronidazole or ciprofloxacin, which produces remission in most cases. Mesalazine has weak evidence in pouchitis, corticosteroids are second line for refractory disease, and pouch excision is a last resort for chronic antibiotic-refractory pouchitis with dysplasia or poor function.
Reference: Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.