Pouchitis disease activity index (PDAI) does not predict patients with symptoms of pouchitis who will respond to antibiotics

Purpose To evaluate whether the pouchitis disease activity index (PDAI) alone is sufficient to select appropriate treatment plans for ulcerative colitis patients with bowel movement problems following ileal pouch-anal anastomosis (IPAA). Methods The study included 70 patients undergoing an IPAA. For these patients, an evaluation by PDAI was performed prospectively at 1–2 years after the ileostomy closure. When the symptoms relevant to bowel movement appeared, PDAI was evaluated and metronidazole or ciprofloxacin was administered. Pouchitis was diagnosed in patients with PDAI scores of 7 or higher. The patients whose PDAI score was less than 7 and who responded to antibiotic therapy were defined as treatment responders having disease not diagnosed by PDAI (TR-NDPDAI). Results Pouchitis was diagnosed in 16 of the 70 enrolled patients (22.9%) using the PDAI scoring system. Of these 16 patients, 11 had acute pouchitis and 5 had chronic pouchitis. Twenty-one patients whose PDAI score was less than 7 were symptomatic. Among them, 12 were TR-NDPDAI. In patients with TR-NDPDAI, antibiotic treatment resulted in significant improvements in the PDAI score ( P < 0.001) and in clinical symptoms ( P < 0.001) after treatment. Conclusion Antibiotic treatment was effective in a considerable number of ulcerative colitis patients whose PDAI score was less than 7 after IPAA.