AGA Clinical Practice Guideline on the Management of Pouchitis and Inflammatory Pouch Disorders

Barnes, Edward L.; Agrawal, Manasi; Syal, Gaurav; Ananthakrishnan, Ashwin N.; Cohen, Benjamin L.; Haydek, John P.; Al Kazzi, Elie S.; Eisenstein, Samuel; Hashash, Jana G.; Sultan, Shahnaz S.; Raffals, Laura E.; Singh, Siddharth

doi:10.1053/j.gastro.2023.10.015

Cited by 21 publications

(10 citation statements)

References 88 publications

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“…Another tested formulation, Clostridium butyricum MIYAIRI, showed significantly lower rates of pouchitis episodes at 2 years in treated patients [ 42 ]. The American Gastroenterological Association (AGA) recommends using probiotics in patients with recurrent episodes of pouchitis that respond to antibiotics for maintenance of remission but suggests avoiding them in patients with infrequent episodes due to the burden associated with long-term excessive use of probiotics [ 43 ]. The European Crohn’s and Colitis Organization (ECCO) suggests the maintenance of antibiotic-induced remission in chronic pouchitis with the De Simone formulation [ 44 ].…”

Section: Treatment Of Idiopathic Pouchitismentioning

confidence: 99%

Diagnosis and Medical Treatment of Acute and Chronic Idiopathic Pouchitis in Inflammatory Bowel Disease

Meianu,

Stroie,

Istratescu

et al. 2024

Medicina

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Despite the decreased rates in inflammatory bowel disease (IBD) colectomies due to high advances in therapeutic options, a significant number of patients still require proctocolectomy with ileal pouch-anal anastomosis (IPPA) for ulcerative colitis (UC). Pouchitis is the most common complication in these patients, where up to 60% develop one episode of pouchitis in the first two years after UC surgery with IPAA with severe negative impact on their quality of life. Acute cases usually respond well to antibiotics, but 15% of patients will still develop a refractory disease that requires the initiation of advanced immunosuppressive therapies. For chronic idiopathic pouchitis, current recommendations suggest using the same therapeutic options as for IBD in terms of biologics and small molecules. However, the available data are limited regarding the effectiveness of different biologics or small molecules for the management of this condition, and all evidences arise from case series and small studies. Vedolizumab is the only biologic agent that has received approval for the treatment of adult patients with moderately to severely active chronic refractory pouchitis. Despite the fact that IBD treatment is rapidly evolving with the development of novel molecules, the presence of pouchitis represents an exclusion criterion in these trials. Recommendations for the approach of these conditions range from low to very low certainty of evidence, resulting from small randomized controlled trials and case series studies. The current review focuses on the therapeutic management of idiopathic pouchitis.

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Section: Treatment Of Idiopathic Pouchitismentioning

confidence: 99%

Diagnosis and Medical Treatment of Acute and Chronic Idiopathic Pouchitis in Inflammatory Bowel Disease

Meianu,

Stroie,

Istratescu

et al. 2024

Medicina

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“…For patients who underwent ileal pouch anal anastomosis and subsequently developed pouchitis, there are some RCTs that demonstrated the benefit of probiotics for primary prevention [ 147 , 148 ]. The AGA, however, graded the available evidence to have very low certainty and thus has not provided a specific recommendation for this [ 149 ]. One RCT with 20 participants of a single-strain probiotic with L. rhamnosus GG did not find a benefit for the treatment of pouchitis [ 150 ].…”

Section: Role Of Prebiotics and Probiotics For Various Gastrointestin...mentioning

confidence: 99%

“…One RCT with 20 participants of a single-strain probiotic with L. rhamnosus GG did not find a benefit for the treatment of pouchitis [ 150 ]. A pooled analysis with two observational trials nonetheless found a benefit of probiotics for clinical response, albeit with very low certainty of evidence [ 149 ]. In this scenario, the AGA similarly has no formal recommendation.…”

Section: Role Of Prebiotics and Probiotics For Various Gastrointestin...mentioning

confidence: 99%

“…In this scenario, the AGA similarly has no formal recommendation. On the other hand, guidelines from the AGA suggest consideration of probiotics for the prevention of recurrent pouchitis [ 149 ]. This conditional recommendation was based on three RCTs that evaluated the efficacy of VSL#3 ® for recurrent pouchitis [ 151 , 152 , 153 ].…”

Section: Role Of Prebiotics and Probiotics For Various Gastrointestin...mentioning

confidence: 99%

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Prebiotics and Probiotics for Gastrointestinal Disorders

Rau,

Gregg,

Yaceczko

et al. 2024

Nutrients

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The complex role of the gut microbiome in the pathogenesis of gastrointestinal (GI) disorders is an emerging area of research, and there is considerable interest in understanding how diet can alter the composition and function of the microbiome. Prebiotics and probiotics have been shown to beneficially modulate the gut microbiome, which underlies their potential for benefit in GI conditions. Formulating specific recommendations for the public regarding these dietary supplements has been difficult due to the significant heterogeneity between strains, doses, and duration of treatment investigated across studies, as well as safety concerns with administering live organisms. This review aims to summarize the existing evidence for the use of prebiotics and probiotics in various GI disorders, paying special attention to strain-specific effects that emerged and any adverse effects noted.

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“…According to ESPEN, prebiotics play no beneficial role in IBD management. Although probiotics are not recommended for patients with CD at any stage of their disease, select probiotics may be considered in patients with mild to moderate UC who could not tolerate 5-aminosalicylic acid (5-ASA) ( 3 ) and in line with recent American Gastroenterological Association (AGA) pouchitis guidelines, multistrain probiotics can be considered to prevent pouchitis in patients with recurrent antibiotic responsive pouchitis ( 10 ). No recommendation was made for or against FMT in the management of IBD, although a recent meta-analysis demonstrated a clinical and endoscopic benefit of FMT in patients with active UC ( 11 ).…”

mentioning

confidence: 99%

Slowly filling the gaps in our approach to diet and nutrition in inflammatory bowel diseases

Mourad,

Hashash

2024

Hepatobiliary Surg Nutr

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AGA Clinical Practice Guideline on the Management of Pouchitis and Inflammatory Pouch Disorders

Cited by 21 publications

References 88 publications

Diagnosis and Medical Treatment of Acute and Chronic Idiopathic Pouchitis in Inflammatory Bowel Disease

Diagnosis and Medical Treatment of Acute and Chronic Idiopathic Pouchitis in Inflammatory Bowel Disease

Prebiotics and Probiotics for Gastrointestinal Disorders

Slowly filling the gaps in our approach to diet and nutrition in inflammatory bowel diseases

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