Adalimumab in the Treatment of Chronic Pouchitis

Inclusion Criteria:

• Operated with proctocolectomy and construction of an IPAA

• Prior to surgery diagnosed with ulcerative colitis according to establishedclinically, radiologic, endoscopic and histological criteria.

• Diagnosed with chronic pouchitis as defined above

• PDAI ≥ 7, with the clinically part of PDAI >2 and the endoscopic part of PDAI >3

• Age >18 years

• Negative stool cultures for bacterial bowel pathogens and negative stool microscopyfor parasites

• Serology negative for chronic hepatitis B

• Negative examination for tuberculosis (including x-ray of thorax and a interferongamma test)

• Signed informed consent

Exclusion Criteria:

• Treatment with glucocorticoids within the last 4 weeks

• Diagnosed with Crohn's disease

• Need of an interpreter or if patients do not understand oral or written information.

• Surgical complications as anal stenosis, leak of the anastomosis, or fistula arisingfrom the pouch

• Abuse of medicine, alcohol or drugs

• Ongoing treatment with NSAID (non steroid anti inflammatory drug)

• Pregnancy or nursing

• A diverting stoma

• Malignancy or other severe chronic disease or expected longevity less than one year

• Patients diagnosed with immune deficiency

• Ongoing infectious disease

• Contraindications against treatment with tumor necrosis factor-alpha antibody, such asheart disease, former cancer disease, in vivo vaccination within the last 4 weeks