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Topical Tacrolimus Therapy for Antibiotic-Refractory Pouchitis

Uchino, Motoi M.D., Ph.D.1,2; Ikeuchi, Hiroki M.D., Ph.D.1,2; Matsuoka, Hiroki M.D., Ph.D.1,2; Bando, Toshihiro M.D.1,2; Hida, Nobuyuki M.D., Ph.D.2,3; Nakamura, Shiro M.D., Ph.D.2,3; Takesue, Yoshio M.D., Ph.D.4; Tomita, Naohiro M.D., Ph.D.1

doi: 10.1097/DCR.0b013e31829ebd83
Original Contributions: Inflammatory Bowel Disease

BACKGROUND: Pouchitis is the most common complication after restorative proctocolectomy for ulcerative colitis, and it leads to pouch failure. The administration of oral antibiotics is the main treatment for pouchitis; however, in some cases, antibiotic-refractory pouchitis may develop, which requires further medical therapy.

OBJECTIVE: We investigated the applicability of topical tacrolimus for refractory pouchitis.

DESIGN: We performed a prospective pilot study. The study protocols were registered with the University Hospital Medical Information Network Clinical Trials Registry, 000006658.

SETTING: This study was conducted in the Surgical Department of Hyogo College of Medicine.

PATIENTS: Patients with antibiotic-refractory pouchitis were treated for 8 weeks with a tacrolimus enema.

MAIN OUTCOME MEASURES: The efficacy was assessed by comparing Pouchitis Disease Activity Index scores. Safety was assessed by measuring whole blood tacrolimus trough levels.

RESULTS: Ten patients with refractory pouchitis were enrolled. No severe adverse events occurred. The mean scores decreased from 15.9 ± 0.8 to 7.8 ± 0.8 during 8 weeks of treatment (p < 0.01). Specifically, the clinical symptom, endoscopic finding, and histological finding subscores decreased to 0.8 ± 0.6, 3.9 ± 0.2, and 2.9 ± 0.4. Nine patients recovered from their clinical symptoms, and 3 patients recovered from pouchitis.

LIMITATIONS: This small study was neither blinded nor randomized.

CONCLUSIONS: This study demonstrates that the use of topical tacrolimus for the treatment of refractory pouchitis is safe and effective in the short term for clinical symptoms. Although complete endoscopic healing was not achieved, this treatment may have early rescue efficacy in the treatment of antibiotic-refractory pouchitis.

1 Department of Lower Gastroenterological Surgery, Hyogo College of Medicine, Hyogo, Japan

2 Inflammatory Bowel Disease Center, Hyogo College of Medicine, Hyogo, Japan

3 Division of Lower Gastroenterology, Hyogo College of Medicine, Hyogo, Japan

4 Infection Control and Prevention, Hyogo College of Medicine, Hyogo, Japan

Funding/Support: Dr Uchino is currently receiving a 2012 Grant-in-Aid for Researchers from Hyogo College of Medicine.

Financial Disclosures: None reported.

Correspondence: Motoi Uchino, M.D., Ph.D., Department of Lower Gastroenterological Surgery, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo 663–8501 Japan. E-mail:

© 2013 The American Society of Colon and Rectal Surgeons