All, I know I have mentioned this in responses to others before, but I wanted to make a Discussion item here to let you know about two meds that are effective (but rarely suggested) for pouchitis. Both have at least one study to back up their efficacy.

The first is our good old friend, Sulfasalazine. I was originally prescribed this by my rheumy, but I noticed that my pouch function improved while on it. The study I read found it to be as effective as antibiotic therapy for pouchitis. Sulfasalazine has antibiotic and anti-inflammatory properties - though the study didn't dive into the exact reasons for it's effectiveness:

According to the PDAI score, 8/11 patients (73%) improved their clinical condition and 7/11 (63%) were in remission at the end of the treatment."

Another effective treatment appears to be PPI's (Proton Pump Inhibitors) like Protonics or Prilosec. After I started taking Prilosec, once a day, I noticed an even more significant improvement in my pouch function. No more 2 good weeks, 2 bad weeks, run to the antibiotics every month or two routine. In addition, butt burn incidence went down significantly. Several different studies on this, including this one from last year:

Our data suggest that the daily use of proton pump inhibitors, H(2) antagonists, or antacids is associated with a decreased risk of pouchitis in ulcerative colitis. Occasional use of these agents did not seem to afford the same protection. These data suggest that altering the pH of the gastrointestinal tract may influence the development of pouchitis."

My daughter was diagnosed after scope with acute, chronic pouchitis. I was able to push her doctor to try the same regimen I am on, so she is on a regimen of these two drugs and is doing quite well. I am not convinced it is totally managing her pouchitis, but she has no functional issues after starting these meds (frequency is great both day and night, and no other symptoms).

Most doctors are going to push you toward antibiotics. Throw some of these studies at them and see if you can find success with one or both of these medicines. Less is more, and I always consider antibiotics to be more.

Original Post
Thanks for posting this. I would love to hear if anyone else has had experience with these and also what are the side effects compared with antibiotics.. That would be very helpful.
No side effects for me, other than some indirect ones:

1. If I miss my Prilosec, my body creates more acid and I get bad heartburn. FYI - if you are on PPI's long-term and want to stop, substitute an acid reducer like Xantac and then gradually wean off of it.

2. It has been shown that long-term use of PPI's (about 3 years) can reduce B-12 absorption. Checking B-12 levels after several years is a good idea

3. Sulfasalazine can affect Potassium levels and I have to get my levels checked every six months. So far, so good. Also, some people cannot take sulfa drugs

Overall though, I still prefer this to the possible neurological side effects from some antibiotics, and knowing that I'm not reducing antibiotic effectiveness from frequent use is a reason to stay on my current course as long as I can.

asked dr shen about both sulfa and prilosec ..for what its worth here is his answer...

"both agents have not been studied.would be careful using prilosec for fear of c-diff...sulfa has been empirically used with both gut and joint symptom.."

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