Oral beclomethasone dipropionate in chronic refractory pouchitis

Background: Pouchitis is the major long-term complication after ileal-pouch anal-anastomosis for ulcerative colitis. Ten to 15% of patients develop chronic pouchitis, either treatment responsive or treatment refractory. Aim: To evaluate the efficacy of oral beclomethasone dipropionate in inducing remission and improving quality of life in patients with chronic refractory pouchitis. Methods: Ten consecutive patients with active pouchitis, not responding to 1-month antibiotic treatment, were treated with beclomethasone dipropionate 10. mg/day for 8. weeks. Clinical, endoscopic and histological evaluations were undertaken before and after treatment, according to the Pouchitis Disease Activity Index (PDAI). Remission was defined as a combination of PDAI clinical score of ≤. 2, endoscopic score of ≤. 1 and a total PDAI score of ≤. 4. The quality of life was assessed with the Inflammatory Bowel Disease Questionnaire (IBDQ). Results: Eight of 10 patients (80%) achieved remission. The median total PDAI scores before and after therapy were, respectively, 12 (range 8-14) and 3 (range 2-9) (P. <. 0.001). The median IBDQ score also significantly improved from 120 (range 77-175) to 175 (range 85-220) (p. <. 0.001). Conclusion: Eight-week treatment with oral beclomethasone dipropionate appears effective in inducing remission in patients with active pouchitis refractory to antibiotic treatment. © 2013 European Crohn's and Colitis Organisation.