Successful treatment of severe pouchitis with rebamipide refractory to antibiotics and corticosteroids:A case report

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 4thwk.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.