O desafio diagnóstico e terapêutico das bolsites nas doenças inflamatórias intestinais: uma revisão de literatura

Abstract

Pouchitis is a frequent inflammatory complication of ileal pouch–anal anastomosis (IPAA), a surgical procedure primarily indicated for patients with ulcerative colitis undergoing total proctocolectomy. This study aimed to review the main pathophysiological, diagnostic, and therapeutic aspects of pouchitis, emphasizing the complexity of its management. The literature review demonstrated that pouchitis has a multifactorial aetiology involving genetic, environmental, immunological, and microbiological factors, particularly intestinal dysbiosis and altered innate immune responses. Diagnosis relies on the correlation of clinical, endoscopic, histologic, and laboratory findings, with PDAI and mPDAI scores widely used to quantify inflammatory activity. Treatment should be individualized, with antibiotics as the first-line therapy and escalation to immunomodulators and biologic agents in cases that are refractory. Ciprofloxacin and metronidazole remain the preferred initial antibiotics, while probiotics and budesonide serve as adjuvant options. Advances in biologic therapies, particularly anti-TNF and anti-IL12/23 agents, have expanded therapeutic options for chronic or refractory pouchitis. Proper management requires a multidisciplinary approach and continuous medical updatings, given the disease’s impact on patients’ quality of life and the importance of preventing structural and infectious complications associated with IPAA.