First Comprehensive Medical Guideline on Management of Pouchitis Released

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Edward Barnes, MD, MPH, co-first author, is an assistant professor in the Division of Gastroenterology and Hepatology and John Haydek, MD, MSCS, author, is an advanced inflammatory bowel diseases fellow.

Drs. Barnes and Haydek

The American Gastroenterological Association (AGA) has released the first comprehensive evidence-based guideline on the management of pouchitis, the most common complication people with ulcerative colitis experience following surgery to remove their colon. The guideline has been published in the journal Gastroenterology.

“In addition to reviewing all available evidence, one of our major goals in crafting this guideline was to offer pragmatic clinical definitions for pouch-related disorders that patients and those involved in the delivery of multidisciplinary care could employ,” Dr. Barnes said.

“We attempted to remove some of the variability among patients and providers, and thus we hope that these definitions will have direct impacts on patient care. In reviewing available evidence, we identified and, in some cases, reaffirmed the role of standard approaches to the management of both intermittent and chronic pouchitis. This includes the key role of antibiotics, along with the role of advanced therapies in patients with chronic inflammatory conditions of the pouch. However, we also identified potential roles for earlier introduction of advanced therapies or preventive therapies based on available evidence and the opinion of the guideline panel. These are examples of areas that will likely be informed by future research and we attempted to be cognizant of the knowledge gaps in this field and opportunities to improve patient care in the future.”

AGA provides the following guidance for physicians caring for patients with ulcerative colitis who undergo proctocolectomy with ileal pouch-anal anastomosis, also known as IPAA or J-pouch:

  • AGA suggests initial treatment of pouchitis with antibiotics.
  • Treatment with multi-strain probiotics following an antibiotic course is suggested for preventing recurrent pouchitis.
  • AGA suggests cyclical or near continuous antibiotic therapy to treat pouchitis that responds to antibiotics but recurs frequently and shortly after antibiotics are discontinued.
  • In patients with recurrent pouchitis that doesn’t respond to antibiotics or Crohn’s-like disease of the pouch, AGA suggests advanced immunosuppressive medications (ie. Infliximab, vedolizumab, ustekinumab, upadacitinib, etc.)

Read the full press release from the American Gastroenterological Association here.

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