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Successful treatment for pouchitis with rebamipide refractory to a combination of metronidazole (MNZ) and ciprofloxacin (CFX)

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Abstract

A 35-year-old male who had undergone proctocolectomy and ileo-anal pouch surgery (IPAA) because of ulcerative colitis presented with worsening diarrhea and hematochezia. Pouchitis was diagnosed, and he was prescribed with metronidazole (MNZ) and a betamethasone enema. However, his condition did not remarkably improve despite these strategies. Endoscopy revealed ulceration and inflammation in the ileal pouch together with contact bleeding and mucous discharge. He underwent granulocytapheresis (G-CAP) and was prescribed anal 5-aminosalicylic acid (5-ASA) and oral prednisolone. Oral azathioprine (AZA) and a combination of MNZ and ciprofloxacin (CFX) did not result in any improvement. He was then treated with rebamipide enemas twice daily for 8 weeks without additional drug therapy. Two weeks thereafter, stool frequency started to decrease, fecal hemoglobin became negative, and his symptoms gradually improved. Endoscopic findings after the rebamipide therapy showed that the ulcers in the ileal pouch had mostly healed without obvious inflammation and bleeding. Rebamipide was thus maintained throughout the therapeutic period and for 13 months of follow-up. Rebamipide effectively treated severe pouchitis that was refractory to intensive conventional medication including antibiotics and corticosteroids.

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References

  1. Hanauer SB. Medical therapy for ulcerative colitis 2004. Gastroenterology. 2004;126:1582–92.

    Article  PubMed  Google Scholar 

  2. Braveman JM, Schoetz DJ Jr, Marcello PW, Roberts PL, Coller JA, Murray JJ, et al. The fate of the ileal pouch in patients developing Crohn’s disease. Dis Colon Rectum. 2004;47:1613–9.

    Article  PubMed  Google Scholar 

  3. Kuisma J, Jarvinen H, Kahri A, Farkkila M. Factors associated with disease activity of pouchitis after surgery for ulcerative colitis. Scand J Gastroenterol. 2004;39:544–8.

    Article  CAS  PubMed  Google Scholar 

  4. Shen B, Fazio VW, Remzi FH, Lashner BA. Clinical approach to diseases of ileal pouch–anal anastomosis. Am J Gastroenterol. 2005;100:2796–807.

    Article  PubMed  Google Scholar 

  5. Achkar JP, Al-Haddad M, Lashner B, Remzi FH, Brzezinski A, Shen B, et al. Differentiating risk factors for acute and chronic pouchitis. Clin Gastroenterol Hepatol. 2005;3:60–6.

    Article  PubMed  Google Scholar 

  6. Shen B, Fazio VW, Remzi FH, Brzezinski A, Bennett AE, Lopez R, et al. Risk factors for diseases of ileal pouch–anal anastomosis after restorative proctocolectomy for ulcerative colitis. Clin Gastroenterol Hepatol. 2006;4:81–9 (quiz 2-3).

    Article  PubMed  Google Scholar 

  7. Mann SD, Pitt J, Springall RG, Thillainayagam AV. Clostridium difficile infection—an unusual cause of refractory pouchitis: report of a case. Dis Colon Rectum. 2003;46:267–70.

    Article  PubMed  Google Scholar 

  8. Munoz-Juarez M, Pemberton JH, Sandborn WJ, Tremaine WJ, Dozois RR. Misdiagnosis of specific cytomegalovirus infection of the ileoanal pouch as refractory idiopathic chronic pouchitis: report of two cases. Dis Colon Rectum. 1999;42:117–20.

    Article  CAS  PubMed  Google Scholar 

  9. Moonka D, Furth EE, MacDermott RP, Lichtenstein GR. Pouchitis associated with primary cytomegalovirus infection. Am J Gastroenterol. 1998;93:264–6.

    Article  CAS  PubMed  Google Scholar 

  10. Tarnawski A, Arakawa T, Kobayashi K. Rebamipide treatment activates epidermal growth factor and its receptor expression in normal and ulcerated gastric mucosa in rats: one mechanism for its ulcer healing action? Dig Dis Sci. 1998;43:90S–8S.

    Article  CAS  PubMed  Google Scholar 

  11. Aihara M, Imagawa K, Funakoshi Y, Ohmoto Y, Kikuchi M. Effects of rebamipide on production of several cytokines by human peripheral blood mononuclear cells. Dig Dis Sci. 1998;43:160S–6S.

    CAS  PubMed  Google Scholar 

  12. Aihara M, Azuma A, Takizawa H, Tsuchimoto D, Funakoshi Y, Shindo Y, et al. Molecular analysis of suppression of interleukin-8 production by rebamipide in Helicobacter pylori-stimulated gastric cancer cell lines. Dig Dis Sci. 1998;43:174S–80S.

    CAS  PubMed  Google Scholar 

  13. Shimada S, Inoue K, Kuramoto M, Suzuki S, Yamamoto K, Ogawa M. Preoperative administration of rebamipide significantly lowers body temperature and circulating interleukin-6 in gastric cancer patients after gastrectomy. Dig Surg. 2003;20:500–5.

    Article  CAS  PubMed  Google Scholar 

  14. Arakawa T, Kobayashi K, Yoshikawa T, Tarnawski A. Rebamipide: overview of its mechanisms of action and efficacy in mucosal protection and ulcer healing. Dig Dis Sci. 1998;43:5S–13.

    CAS  PubMed  Google Scholar 

  15. Makiyama K, Takeshima F, Hamamoto T. Efficacy of rebamipide enemas in active distal ulcerative colitis and proctitis: a prospective study report. Dig Dis Sci. 2005;50:2323–9.

    Article  CAS  PubMed  Google Scholar 

  16. Makiyama K, Takeshima F, Kawasaki H, Zea-Iriarte WL. Anti-inflammatory effect of rebamipide enema on proctitis type ulcerative colitis: a novel therapeutic alternative. Am J Gastroenterol. 2000;95:1838–9.

    Article  CAS  PubMed  Google Scholar 

  17. Shanahan F. Inflammatory bowel disease: immunodiagnostics, immunotherapeutics, and ecotherapeutics. Gastroenterology. 2001;120:622–35.

    Article  CAS  PubMed  Google Scholar 

  18. Hanauer SB, Present DH. The state of the art in the management of inflammatory bowel disease. Rev Gastroenterol Disord. 2003;3:81–92.

    PubMed  Google Scholar 

  19. Faubion WA Jr, Loftus EV Jr, Harmsen WS, Zinsmeister AR, Sandborn WJ. The natural history of corticosteroid therapy for inflammatory bowel disease: a population-based study. Gastroenterology. 2001;121:255–60.

    Article  CAS  PubMed  Google Scholar 

  20. Fazio VW, Ziv Y, Church JM, Oakley JR, Lavery IC, Milsom JW, et al. Ileal pouch–anal anastomoses complications and function in 1005 patients. Ann Surg. 1995;222:120–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Pemberton JH, Kelly KA, Beart RW Jr, Dozois RR, Wolff BG, Ilstrup DM. Ileal pouch–anal anastomosis for chronic ulcerative colitis. Long-term results. Ann Surg. 1987;206:504–13.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Mahadevan U, Sandborn WJ. Diagnosis and management of pouchitis. Gastroenterology. 2003;124:1636–50.

    Article  PubMed  Google Scholar 

  23. Gionchetti P, Morselli C, Rizzello F, Romagnoli R, Campieri M, Poggioli G, et al. Management of pouch dysfunction or pouchitis with an ileoanal pouch. Best Pract Res Clin Gastroenterol. 2004;18:993–1006.

    Article  PubMed  Google Scholar 

  24. Genta RM. Review article: the role of rebamipide in the management of inflammatory disease of the gastrointestinal tract. Aliment Pharmacol Ther. 2003;18(Suppl 1):8–13.

    Article  CAS  PubMed  Google Scholar 

  25. Arakawa T, Watanabe T, Fukuda T, Yamasaki K, Kobayashi K. Rebamipide, novel prostaglandin-inducer accelerates healing and reduces relapse of acetic acid-induced rat gastric ulcer. Comparison with cimetidine. Dig Dis Sci. 1995;40:2469–72.

    Article  CAS  PubMed  Google Scholar 

  26. Tarnawski AS, Chai J, Pai R, Chiou SK. Rebamipide activates genes encoding angiogenic growth factors and Cox2 and stimulates angiogenesis: a key to its ulcer healing action? Dig Dis Sci. 2004;49:202–9.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Gastroenterology, Aichi Medical University School of Medicine, 21 Karimata, Yazako, Nagokute-cho, Aichi, 480-1195, Japan

    Naotaka Ogasawara, Makoto Sasaki, Yasutaka Hijikata, Ryuta Masui & Kunio Kasugai

  2. Departments of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Science, 1-Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan

    Satoshi Tanida, Takayoshi Kanematsu, Takeshi Kamiya, Hiromi Kataoka & Takashi Joh

Authors
  1. Naotaka Ogasawara
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  2. Makoto Sasaki
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  3. Yasutaka Hijikata
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  4. Ryuta Masui
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  5. Satoshi Tanida
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  6. Takayoshi Kanematsu
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  7. Takeshi Kamiya
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  8. Hiromi Kataoka
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  9. Takashi Joh
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  10. Kunio Kasugai
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Correspondence to Makoto Sasaki.

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Ogasawara, N., Sasaki, M., Hijikata, Y. et al. Successful treatment for pouchitis with rebamipide refractory to a combination of metronidazole (MNZ) and ciprofloxacin (CFX). Clin J Gastroenterol 2, 404–407 (2009). https://doi.org/10.1007/s12328-009-0115-7

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  • DOI: https://doi.org/10.1007/s12328-009-0115-7

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