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Hey there fellow pouchers,

So I know what the GI docs say refractory and/or chronic pouchitis is. Chronic pouchitis is pouchitis that pretty much needs to be treated continuously by rotating antibiotics. Refractory would be pouchitis that isn't responding to ABX treatment anymore...

But for those who have looked further into it or have seen a doctor that is a real authority on the subject (Shen?), what is different about this more severe pouchitis? Why does pouchitis respond to ABX for like 7 years in my case, then become almost unresponsive? What is really going on? Should it actually be called small intestine bacteria overgrowth? Is that what is really going on, bacteria overgrowth has occurred to a much greater extent in the pouch and on up the small bowel; therefore, it is too much for antibiotics to treat successfully anymore?

I ask because I am trying to understand how to try and treat it with a drastic diet approach. If it is better thought of as SIBO w/an IBD reaction component to it, then a Paleo diet may be helpful or even the SCD diet. I'll save this diet discussion for my next post.

For now I'm trying to figure out what other pathological entity is refractory/chronic pouchitis most similar to. So I can research it and understand what might and might not work.

Thank you in advance for your responses.
Mike
Original Post
Actually, I believe that chronic refractory pouchitis is more akin to IBD than to what you are thinking about small intestine bacterial overgrowth. The difference is that with the SIBO, there is not the tell-tale infamed pouch that you see with pouchitis. Symptoms can be similar though, and so is the treatment.

This is also why sometimes drugs like steroids, 5-ASAs, biologics, etc. are also used to treat refractory pouchitis.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3093723/

http://gastro.ucsd.edu/fellows...%20Review%202009.pdf

Like IBD, response to treatment is variable and can change over time in the same person. For some, refractory pouchitis is an indication of Crohn's disease. Good luck finding a diet that will turn this around for you, as that also is highly variable. From what I've been seeing here, the best results have been with paleo-type diets, even if it is not a "cure."

Jan Smiler

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