Preventive effect of Clostridium butyricum MIYAIRI against pouchitis in children with ulcerative colitis

Purpose: Pouchitis is a major complication after ileal pouch–anal anastomosis (IPAA) for ulcerative colitis in children (UCc). In this study, we investigated whether the oral administration of Clostridium butyricum MIYAIRI 588 (CBM) can reduce the incidence of pouchitis after IPAA in UCc. Methods: We reviewed the data for pediatric patients with UC, who underwent IPAA in Mie University Hospital between 2004 and 2022. Data on the presence and type of postoperative probiotic medication and the timing of probiotic initiation, as well as clinical variables, were collected from the patients’ medical records. Results: During the study period, 55 children with UC underwent radical surgery. During the first 5 years after ileostomy closure, 23 (41.8%) patients suffered at least one pouchitis episode. The incidence of acute pouchitis was significantly lower in the CBM group than in the non-CBM group (CBM vs. non-CBM: 10.5% vs. 58.3%, p < 0.01). Furthermore, even among patients who had been taking any probiotics postoperatively, the CBM group had a significantly lower incidence of both acute and chronic pouchitis than the ‘other probiotics’ group (p < 0.01). Conclusion: Oral CBM administration after ileostomy closure may be effective in preventing postoperative pouchitis.