Clostridium difficile-associated refractory pouchitis: Report of three cases

Pouchitis-the most common complication of total proctocolectomy and anal ileal-pouch anastomosis for ulcerative colitis-is effectively treated in most patients by antibiotic ciprofloxacin or metronidazole therapy, In some cases, however, pouchitis is refractory to these antibiotics. We detected Clostridium difficile toxin A in the feces of three patients suffering from antibiotic-refractory pouchitis whose mucosal inflammation was ameliorated by oral vancomycin treatment. C. difficile should therefore be considered in antibiotic-refractory pouchitis, which requires appropriate medication.