The American Gastroenterological Association (AGA) has published the first comprehensive guideline on the management of pouchitis and other inflammatory pouch disorders. This guideline is particularly aimed at patients with ulcerative colitis who have undergone ileal pouch-anal anastomosis (IPAA) surgery. Edward L. Barnes, MD, MPH, from the University of North Carolina at Chapel Hill, emphasized the increasing unmet needs in research and the burden of disease for patients and the healthcare system regarding pouchitis.
The guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework. It includes nine conditional recommendations based on clinical questions, patient outcomes, and evidence review. The focus of the guideline is on the primary prevention of pouchitis after IPAA, treatment of pouchitis, prevention of recurrent and/or refractory pouchitis, and treatment of Crohn’s-like disease of the pouch and cuffitis.
Key highlights from the recommendations include:
- Advising against the use of antibiotics for the primary prevention of pouchitis in patients with UC who have undergone IPAA.
- Suggesting the use of probiotics to prevent recurrent episodes of antibiotic-responsive pouchitis.
- Recommending chronic antibiotic therapy or advanced immunosuppressive therapy for the treatment of recurrent pouchitis in patients who responded to antibiotics but relapsed shortly after stopping treatment.
- Suggesting the use of advanced immunosuppressive therapies or corticosteroids for patients with recurrent pouchitis who have an inadequate response to antibiotics.
- Advising the use of corticosteroids or advanced immunosuppressive therapy for patients with symptoms due to Crohn’s-like disease of the pouch.