LONG-TERM EFFICACY OF BISMUTH CARBOMER ENEMAS IN PATIENTS WITH TREATMENT-RESISTANT CHRONIC POUCHITIS

Background: Mucosal inflammation of the ileal pouch (pouchitis) is the major long-term complication after ileal pouch-anal anastomosis for u lcerative colitis. Broad-spectrum antibiotics are the mainstay of trea tment, however, 15% of patients with pouchitis have a chronic, treatme nt-resistant disease. Aim: To determine the safety and efficacy of bis muth carbomer enemas in achieving and maintaining remission in treatme nt-resistant chronic pouchitis. Methods: Twelve patients with treatmen t-resistant chronic pouchitis were treated nightly for 45 days with en emas containing elemental bismuth complexed with carbomer. Diagnosis o f pouchitis and response to treatment were evaluated with the Pouchiti s Disease Activity Index (PDAI), which includes clinical, sigmoidoscop ic and histological criteria. Serum bismuth concentrations were determ ined by atomic absorption. Results: Ten of 12 patients (83%) went into remission, with a significant decrease of mean total PDAI score from 12 (range 9-15) to 6 (4-15) (P < 0.002), and were continued on bismuth carbomer enemas administered every third night for 12 months. Patient s were monitored clinically, sigmoidoscopically and histologically eve ry 2 months for evidence of recurrence (increase greater than or equal to 2 in the clinical symptom portion of the PDAI). Six of 10 patients (60%) were able to maintain remission throughout the 12-month trial; 4/10 had an exacerbation, two of which occurred soon after discontinui ng daily treatment. Serum bismuth levels were negligible in al) patien ts and no side-effects were registered. Conclusions: Our findings sugg est that bismuth carbomer enemas are safe and effective in achieving a nd maintaining remission in patients with treatment-resistant chronic pouchitis.