Novel approaches for pouchitis and colitis with or without diversion

Management of pouchitis as well as colitis can be challenging. For those who are not candidates for reestablishment of fecal continuity, the management of diversion pouchitis and diversion colitis can be even more difficult. Antimicrobial agents, probiotics, and prebiotics have been extensively used for the treatment of infectious and inflammatory disorders of the gut. Fibers are commonly used as dietary supplements for the healthy and diseased. Current theory holds that the therapeutic effects of probiotics and fibers are mainly associated with modulation of gut microbiota and their interaction with gut immune system. Based on a series of experiments, we found that a combination of probiotics and dietary fiber supplement provides synergistic effects, through production of above-physiological quantity of short-chain fatty acids (SCFAs). Among wide applications of SCFAs in the treatment of human diseases are pouchitis and colitis, diversion pouchitis, and diversion colitis. The combination approach will set a perfect example for future medical therapy using synergistic effects of various agents, which can be applied to other disease conditions of gastrointestinal or extraintestinal organs. Pouchitis and diversion pouchitis with sequential events of surgery can serve as a longitudinal model for the investigation of interactions between endogenous and exogenous microbiota and fibers and their products in pouchitis, inflammatory bowel diseases and other gastrointestinal disorders.