medical treatment as labelled as treatment responsive or treatment refractory, with the medication for either case being specified. Treatment First line treatment is usually with antibiotics, specifically with ciprofloxacin and metronidazole. Ampicillin or piperacillin can also be considered as alternatives to empiric ciprofloxacin and metronidazole. Administration of metronidazole at a high daily dose of 20 mg/kg can cause symptomatic peripheral neuropathology in up to 85% of patients. This can be a limiting factor in the use of maintenance metronidazole to suppress chronic pouchitis. Other therapies which have been shown to be effective include probiotics for pouchitis, the application of which usually begins as soon as any antibiotic course is completed so as to re-populate the pouch with beneficial bacteria. The most clinically researched multi-strain probiotic for pouchitis is the De Simone Formulation (formulation name) invented by medical doctor Professor Claudio De Simone. It is currently sold under a variety of brand names globally including Visbiome in the U.S. and Canada, Vivomixx in Europe, and Innovall CU in Germany. Biologics, such as anti-tumor necrosis factor antibodies, may also be useful but the evidence for their use is largely anecdotal. Research A pilot study on the effect of reducing dietary FODMAP intake on bowel function in people without a colon indicates there might be a relation between pouchitis and FODMAP diets. Alicaforsen (an antisense inhibitor which targets the messenger RNA for the production of human ICAM-1 protein) was evaluated in a Phase 3 clinical trial, which did not meet the co-primary endpoints in the primary analysis (an adaptation of the Mayo Score of improvement in endoscopic remission and bowel frequency). References External links Gastrointestinal tract disorders