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Just had a routine scoping today with my pouch.  No symptoms to report that arent 'normal' for me (no blood, no ulcers, no change in frequency etc).  I watch the process on the screen as i always do.  certainly i couldnt see anything different.  Doc said i had mild pouchitis and prescribed flagyl.

Im UK based btw, so dont neccessarily see the same doc everytime.   I appreaciate he is still a highly trianed and qualified profesional, but he just seemed a bit quick with the prescription pad for my liking...

1)  Would there be any merit in not taking the prescription and seeing if i get any symptoms first?

2) If i do take the antibiotics, how badly is it going to affect the gut.  I take probiotics daily and will buy a second type of probiotic for the duration of the course too if i do that them.

my diet is completely normal with no restrictions but i will up the vegetable count for the forseeable too

Any thoughts appreciated :_)

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It's not at all clear what microbiome is best for a J-pouch, so there may not be much reason to guard it quite so carefully. If your doc saw pouchitis it might be best to treat it, but you could choose to wait until symptoms appear. In my experience the symptoms sometimes came on so gradually that instead of noticing that I have a problem my life just slowly got worse and worse. I've been on Flagyl for years now, and I care a lot more about my quality of life (which is excellent) than about trying to protect the bacteria in my pouch.

Untreated inflammation in the pouch can cause some problems over time, so some docs treat pouchitis aggressively to prevent those problems.

Interestingly i see that a recent (2018) study shows that taking probiotics to recover from from antibiotic treatment could actually be counter intuitive... gah....theres never any clear answers is there..

Post-Antibiotic Gut Mucosal Microbiome Reconstitution Is Impaired by Probiotics and Improved by Autologous FMT

Basically the prevleance of a few strains of good bacteria that you have supplemented hinders the ability of other healthy strains to get a foothold.  People who didnt take prebitoics recovered normal gut flora in 3 weeks, people that supplemented with probitoics hadnt recovered within the 6 month trial!

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