Oral budesonide in the treatment of chronic refractory pouchitis

Aliment Pharmacol Ther. 2007 May 15;25(10):1231-6. doi: 10.1111/j.1365-2036.2007.03306.x.


Background: Pouchitis is the major long-term complication after ileal-pouch nal anastomosis for ulcerative colitis. Ten to 15% of patients develop a chronic pouchitis, either treatment responsive or treatment refractory.

Aim: To evaluate the efficacy of oral budesonide in inducing remission and improving quality of life in patients with chronic refractory pouchitis.

Methods: Twenty consecutive patients with active pouchitis, not responding after 1 month of antibiotic treatment were treated with budesonide controlled ileal release 9 mg/day for 8 weeks. Symptomatic, endoscopic and histological evaluations were undertaken before and after treatment according to Pouchitis Disease Activity Index. Remission was defined as a combination of Pouchitis Disease Activity Index clinical score of < or = 2, endoscopic score of < or = 1 and total Pouchitis Disease Activity Index score of < or = 4. The quality of life was assessed with the Inflammatory Bowel Disease Questionnaire.

Results: Fifteen of 20 patients (75%) achieved remission. The median total Pouchitis Disease Activity Index scores before and after therapy were, respectively, 14 (range 9-16) and 3 (range 2-10) (P < 0.001). The median Inflammatory Bowel Disease Questionnaire score also significantly improved from 105 (range 77-175) to 180 (range 85-220) (P < 0.001).

Conclusion: Eight-week treatment with oral budesonide appears effective in inducing remission in patients with active pouchitis refractory to antibiotic treatment in this open-label study.

Publication types

  • Clinical Trial

MeSH terms

  • Administration, Oral
  • Adult
  • Anti-Bacterial Agents / therapeutic use
  • Anti-Infective Agents / administration & dosage*
  • Budesonide / administration & dosage*
  • Chronic Disease
  • Colitis, Ulcerative / surgery
  • Delayed-Action Preparations
  • Female
  • Humans
  • Male
  • Middle Aged
  • Patient Compliance
  • Pouchitis / drug therapy*
  • Quality of Life / psychology*
  • Treatment Outcome


  • Anti-Bacterial Agents
  • Anti-Infective Agents
  • Delayed-Action Preparations
  • Budesonide