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Probiotics for Treatment of Chronic Pouchitis

For many, the most common problem after a BCIR is pouchitis, which is the development of recurrent mucosal inflammation within the pouch. The etiology and pathophysiology of pouchitis are not well understood but it likely results from an interaction between a patient who is genetically susceptible and the small bowel mucosa which is exposed to fecal stasis (retention) and bacterial over growth.

Episodes of pouchitis may be acute and intermittent or chronic and unremitting. Antibiotics continue to be the treatment for acute and intermittent pouchitis while oral administration of probiotics for some has been effective in the prevention of relapses in individuals with chronic pouchitis. As our knowledge and experience with probiotics continues to increase, we want to share this information with you.

People normally have large numbers of a wide variety of bacteria on their skin, in their mouth, nose, vagina and in their large intestine or colon. Each individual's pattern is unique relative to the type and percentage of individual bacteria. Bacterial patterns can be altered by changes in diet, environment and antibiotic usage. It also can be changed when the colon is removed. Continent pouches store stool, which allows the growth of bacteria, but it is a new pattern of bacteria. This new pattern can be problematic for some.

Probiotics are dietary supplements of live microorganisms which when administered in adequate amounts, may provide a health benefit. It is felt that it improves the intestinal microbial balance. Documented studies have shown alleviation of chronic intestinal inflammatory disease, i.e. pouchitis.

There are many probioitics on the market today with various bacterial types and counts. What is good for one is not necessarily good for others. Up until recently, all probiotics have been considered over the counter supplements with various out of pocket expenses. This expense alone has prohibited some from considering this option. Most recently prescription strength has become available and as a result some of the insurance plans are providing benefits. The prescription brand is called VSL#3 Double Strength. We are not indicating that this is the only brand to use but we are very excited that for some, there will be coverage. Before requesting a prescription, you should contact your drug plan to see if this is an option. If so, your local health care provider should be able to provide you with a prescription or as always we are available.

Stay healthy!

Ernest Rehnke, M.D.