The American Gastroenterological Association (AGA) announced new comprehensive guidelines to help physicians manage patients with pouchitis and improve access to advanced therapies. The AGA explained that up to 300,000 patients with ulcerative colitis require proctocolectomy with ileal pouch-anal anastomosis. Pouchitis, the most common complication of this procedure, occurs when the pouch becomes inflamed. In the new evidence-based guidelines published by Barnes et al in Gastroenterology, the AGA suggested that physicians avoid the use of antibiotics and probiotics for primary prevention. They further outlined the four types of inflammatory pouch disorders: intermittent pouchitis, characterized by infrequent episodes of pouchitis symptoms that respond to treatment; chronic antibiotic-dependent pouchitis, in which the disease responds to antibiotics but recurs after cessation of treatment; chronic antibiotic-refractory pouchitis, marked by continuous pouchitis symptoms that require more advanced treatment than antibiotics; and Crohn’s-like disease of the pouch, where patients may experience fistulas and strictures. Among the new recommendations were:

• Initial treatment of pouchitis should consist of antibiotics
• Multistrain probiotics may help prevent disease recurrence following antibiotics
• Physicians can administer cyclical or near-continuous antibiotic therapy for frequently recurring pouchitis
• Patients who do not respond to therapy and experience recurrent pouchitis may be treated with advanced immunosuppressive agents such as infliximab, vedolizumab, ustekinumab, and upadacitinib.

“These guidelines can help patients understand that pouchitis is a real condition, there is treatment for it, and that they don’t have to live with symptoms,” underscored Amber Tresca, a pouchitis patient advocate.