There is also no clear consensus regarding the best treatment among the greater mental health professional community which included clinical psychologists, social workers, licensed therapists MFTs) and psychiatrists. Although most trauma neuroscientifically informed practitioners understand the importance of utilizing a combination of both top down and bottom up interventions as well as including somatic interventions (sensorimotor psychotherapy or somatic experiencing or yoga) for the purposes of processing and integrating trauma memories. Survivors with complex trauma often struggle to find a mental health professional who is properly trained in trauma informed practices. They can also be challenging to receive adequate treatment and services to treat a mental health condition which is not universally recognized or well understood by general practitioners. Allistair and Hull echo the sentiment of many other trauma neuroscience researchers (including Bessel van der Kolk and Bruce D. Perry) who argue: 

Complex presentations are often excluded from studies because they do not fit neatly into the simple nosological categorisations required for research power. This means that the most severe disorders are not studied adequately and patients most affected by early trauma are often not recognised by services. Both historically and currently, at the individual as well as the societal level, "dissociation from the acknowledgement of the severe impact of childhood abuse on the developing brain leads to inadequate provision of services. Assimilation into treatment models of the emerging affective neuroscience of adverse experience could help to redress the balance by shifting the focus from top-down regulation to bottom-up, body-based processing."
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


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