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The antibiotics,metronidazole and ciprofloxacin,arethe first-line treatment for pouchitis.Patients who donot respond to antibiotics or conventional medicationsrepresent a major challenge to therapy.In this report,we have described a successful treatment of severerefractory pouchitis with a novel agent,rebamipide,known to promote epithelial cell regeneration andangiogenesis.A 27-year-old male with ileo-anal pouchsurgery presented with worsening anal pain,diarrhea,and abdominal pain.The patient was diagnosed tohave pouchitis and was given metronidazole togetherwith betamethasone enema(3.95 mg/dose).However,despite this intensive therapy,the patient did notimprove.On endoscopy,ulceration and inflammationwere seen in the ileal pouch together with contactbleeding and mucous discharge.The patient was treatedwith rebamipide enema(150 mg/dose)twice a day for 8 wkwithout additional drug therapy.Two weeks after therebamipide therapy,stool frequency started to decreaseand fecal hemoglobin became negative at the 4~(th) wk.Atthe end of the therapy,endoscopy revealed that ulcers inthe ileal pouch had healed with no obvious inflammation.The effect of rebamipide enema was dramatic and wasmaintained throughout the 11-mo follow-up.The patientcontinued to be in remission.No adverse effects wereobserved during the treatment or the follow-up period.The sustained response seen in this case with severeand refractory pouchitis indicates that agents,whichpromote epithelial cell growth,angiogenesis and mucosaltissue regeneration,are potential therapeutic agents forthe treatment of refractory colorectal lesions.
The antibiotics, metronidazole and ciprofloxacin, are the first-line treatment for pouchitis. Patients who donot respond to antibiotics or conventional medicationsrepresent a major challenge to therapy. This report, we have described a successful treatment of severe refractory pouchitis with a novel agent, rebamipide, known to promote epithelial cell regeneration and angiogenesis. A 27-year-old male with ileo-anal pouchsurgery presented with worsening anal pain, diarrhea, and abdominal pain. the patient was diagnosed to have pouchitis and was given metronidazole together with betamethasone enema (3.95 mg / dose Despite this intensive therapy, the patient did notimprove. Endoscopy, ulceration and inflammation were seen in the ileal pouch together with contactbleeding and mucous discharge. The patient was treated with rebamipide enema (150 mg / dose) twice a day for 8 wkwithout additional drug therapy. TWO weeks after therebamipide therapy, stool frequency started to decreaseandfecal hemoglobin became negative at the 4 ~ (th) wk. At the end of the therapy, endoscopy revealed that ulcers inthe ileal pouch had healed with no obvious inflammation. The effect of rebamipide enema was dramatic and was marginated throughout the 11-mo follow-up. patientcontinued to be in remission. Non-adverse effects wereobserved during the treatment or the follow-up period. sustained be seen in this case with severe and refractory pouchitis that those agents, whichpromote epithelial cell growth, angiogenesis and mucosal ischemia regeneration, are potential therapeutic agents forthe treatment of refractory colorectal lesions.