The Gut Microbiome in Pouchitis: A Narrative Review of Pathogenesis and Therapeutic Modulation
Abstract
Pouchitis is the most common long-term complication following restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC), with a cumulative prevalence of up to 50% within the first two years after IPAA surgery. Accumulating evidence implicates gut microbial dysbiosis in the pathogenesis of pouch inflammation, supported by characteristic microbial alterations and the clinical responsiveness of pouchitis to microbiota-directed therapies such as antibiotics and probiotics. This narrative review synthesizes evidence mainly published in the last decade on microbiota alterations in pouchitis, the mechanisms of microbiota-host interactions that may contribute to inflammation, and the clinical evidence linking the gut microbiota to disease development and progression. Therapeutic strategies for modulating the pouch microbiota, including probiotics, prebiotics, dietary interventions, antibiotics, and fecal microbiota transplantation, are critically evaluated. Finally, future directions in multi-omics profiling, precision microbiome medicine, and next-generation live biotherapeutics are discussed. Overall, current evidence supports antibiotics as the first-line treatment for pouchitis, although it does not restore microbial eubiosis. Among microbiota-targeted interventions, the eight-strain De Simone formulation has the strongest evidence for prevention, whereas faecal microbiota transplantation remains investigational and is not currently…
Read the paper
Related studies
- Promising Sources of Plant-Derived Polyunsaturated Fatty Acids: A Narrative Review
- Effects of omega-3 polyunsaturated fatty acid intake in patients with chronic kidney disease: Systematic review and meta-analysis of randomized controlled trials
- Effect of omega-3 fatty acids on cognition: an updated systematic review of randomized clinical trials
- The role of omega-3 polyunsaturated fatty acid supplementation in the management of type 2 diabetes mellitus: A narrative review
- Paucity of evidence for a relationship between long-chain omega-3 fatty acid intake and chronic obstructive pulmonary disease: a systematic review
- Omega-3 fatty acid nanocarriers: Characterization and potential applications
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.