Clostridium Difficile-associated Refractory Pouchitis: Report of Three Cases

Hitoshi Ogawa, Kouhei Fukushima¹⁾²⁾, Chikashi Shibata, Koh Miura, Sho Haneda, Keiichi Hayashi, Hideyuki Suzuki, Iwao Sasaki, Ken-ichi Takahashi³⁾ and Yuji Funayama³⁾

Department of Surgery, Division of GI tract¹⁾ and Division of Surgical and Molecular Pathophysiology²⁾, Tohoku University Graduate School of Medicine
Division of Colorectal Surgery, Tohoku Rousai Hospital³⁾

Pouchitis-the most common complication of total proctocolectomy and anal ileal-pouch anastomosis for ulcerative colitis-is effectively treated in most patients by antibiotic ciprofloxacin or metronidazole therapy, In some cases, however, pouchitis is refractory to these antibiotics. We detected Clostridium difficile toxin A in the feces of three patients suffering from antibiotic-refractory pouchitis whose mucosal inflammation was ameliorated by oral vancomycin treatment. C. difficile should therefore be considered in antibiotic-refractory pouchitis, which requires appropriate medication.

Key words
pouchitis, C. Difficile

Reprint requests
Hitoshi Ogawa Division of Biological Regulation and Oncology and Department of Surgery, Tohoku University Postgraduate School of Medicine
1-1 Seiryou-machi, Aoba-ku, Sendai, 980-8574 JAPAN

Accepted
July 22, 2009

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