Refractory pouchitis improves after administration of the green tea polyphenol EGCG: a retrospective review

Ulcerative colitis (UC) is a common, chronic, inflammatory process limited to the colon. UC affects up to 1 million individuals in the USA alone and requires resection in up to 30% of patients. Resection is often followed by creation of a pouch. Pouchitis is the most common complication of ileal pouch-anal anastomosis (IPAA) following total proctocolectomy, affecting up to 50% of patients. Symptoms include increased stool frequency, urgency, cramping, and bleeding. Management of pouchitis is complex in antibiotic refractory cases. Plant-based polyphenolic compounds have shown protective effects against UC. We conducted a retrospective review of pouchitis patients treated with EGCG 200-400 mg twice daily. Seven of nine (78%) patients experienced significant improvement based on reduced frequency of bowel movements and bleeding, while five of nine (56%) experienced complete relief. One patient experienced no improvement with EGCG, and one had progression of pouchitis symptoms while taking EGCG. No significant adverse events were noted by patients while taking EGCG. The green tea-derived molecule EGCG exhibits an efficacy signal in the IBD-related condition of pouchitis. Impressively, 78% of patients experienced noticeable improvement in pouchitis symptoms after initiation of EGCG, while 56% of treated patients entered complete remission. These positive responses to EGCG in patients with pouchitis suggests the need to confirm these findings in a formal, controlled trial. Based on recent findings documenting its effects on epithelial permeability and mucosal inflammation, combined with its favorable safety profile, a possible preventative role could also be explored.