Highly concentrated probiotics prevent pouchitis onset

Background and Aim: Pouchitis is the major long-term complication after ileal-pouch-anal-anastomosis for ulcerative colitis. Most patients have the first episode within the first year after ileostomy closure. Recently we have shown the efficacy of a highly concentrated probiotic preparation (VSL#3; 300 billions/g lyophilised viable bacteria) in preventing relapses of chronic pouchitis. The aim of our study was to compare the efficacy of an oral probiotic therapy versus placebo in the prophylaxis of onset of acute pouchitis. Methods: Forty consecutive patients who underwent IPAA for ulcerative colitis were randomised to receive either VSL#3 (3 g/day) (n=20) or a placebo (n=20), immediately after ileostomy closure, for one year. Clinical, endoscopic and histologic examinations were performed after 1,3,6,9 and 12 months. The diagnosis of pouchitis was made when clinical suspect was confirmed by endoscopic and histologic presence of intlammation according to the Pouchitis Disease Activity Index (PDAI) by Sandbom et al. Results: Two of 20 patients (10%) treated with VSL#3 had an episode of acute pouchitis compared to 8 of 20 patients (40%) treated with placebo (student t-test, p