Irritable Pouch Syndrome

A small minority of IPAA patients will experience symptoms suggestive of pouchitis, but investigations reveal little inflammation and the absence of pouch outlet or other problems. These patients respond poorly to antibiotic therapy and are best considered as having "irritable pouches" (Schmidt et al, 1995). Empiric use of antidiarrheals or antispasmidics and fiber supplements is the most prudent approach.^

^Editor's Note: If the dose of metronidazole is less than 1g/d, peripheral neuropathy is rare.

^Editor's Note: Some patients give a history of classic irritable bowel syndrome (IBS) as teenagers, years before the onset of UC. If they have an IPAA, the ileum is as spastic as their colon had been as a teenager. Their pouches hold only 90 cc; on average they are only able to expel half of the contents so they experience 10 to 20 bowel movements per day. Some do better with decyclonine than with loperamide, which contracts the pouch. I tend to urge against an IPAA in a patient with severe preexisting IBS.

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Peripheral Neuropathy Natural Treatment Options

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