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Background: Poor pouch function is associated with impaired bile acid absorption and increased faecal loss of bile acids. Bile acid replacement therapy might therefore be of clinical benefit, provided that diarrhoea is not aggravated by therapy. Aim: To investigate the role of exogenous bile acid therapy in patients with poor pouch function after restorative proctocolectomy for ulcerative colitis. Patients and methods: Twenty ulcerative colitis patients with poor pouch function (score > 4 on a 12-point score) were recruited for inclusion to a prospective, randomized, double-blind crossover, placebo-controlled trial of ursodeoxycholic acid (10 mg/kg per day in two divided doses for 1 month). Results: A total of 16 patients completed the study. There was no significant difference in the functional score or bowel frequency following treatment irrespective of whether the active treatment was given before or after placebo. Conclusions: We conclude that ursodeoxycholic acid given over 4 weeks had no influence on functional score or bowel frequency after restorative proctocolectomy for U.C.

Pouchitis occurs in 10-35% of patients in the first 10 years after pouch construction for ulcerative colitis. Pouchitis must be carefully defined and should not include patients with poor function or Crohn's disease. Most patients have only a single attack of pouchitis which rapidly resolves with metronidazole. Chronic pouchitis suggests some other abnormality of function which, if responsible for persistent poor function, may necessitate pouch excision.