Pouch Review from Laura Raffals, MD at #ACG2019

▪️Pouch anatomy (J, S, W, K)
▪️Endoscopic landmarks of J
▪️Pouch complications DDx
▪️Treatment algorithm for pouchitis

#GITwitter #IBD

J-pouch anatomy:
- appreciating the anatomy & accurate endoscopic reporting is critical in understanding the aetiology of 'pouchitis'
- different segmental involvement suggest different causes --> different rx approaches

#IBD Horizons24 #BrianFeagan

Research in #IBD :
VDZ works well for pouchitis
UPA for #UlcerativeColitis
Risa for #Crohns
Combo is the way to go, no monotherapy for UC
IL23’s likely more effective than the others

Tofacitinib in induction of remission in chronic pouchitis the STOPit trial

Presented by Emi Khoo at Digestive Disease Week #DDW2024

Mucosal healing with VDZ in chronic pouchitis, evidence from the EARNEST trial presented by Vipul Jairath MBChB DPhil #ecco2023 #IBD

Pouch disorders are challenging to manage:

- antibiotics still the mainstay rx for acute/chronic pouchitis
- budesonide or topical steroids
- anti-TNF, vedolizumab for chronic antibiotic-refractory pouchitis or Crohn's-like disease of the pouch

doi: 10.1038/s41575-024-00920-5

Fecal microbiota transplantation is no better than placebo for chronic pouchitis, and had ⬆️ adverse events.

#MedTwitter #GITwitter #IBD #FMT #microbiome

academic.oup.com/ecco-jcc/advan…

📷Faculty Retroflexions📷

🚨High yield! Dr. David Eskreis gives us insight regarding the AGA Guidelines on the Management of Pouchitis and Inflammatory Pouch Disorders. Please see our fellow’s (Andres Rodriguez, DO, MBA) associated visual abstract!
#FacultyRetroflexions #EmoroidDigest

****ANNOUNCING***

GI Paper Breakdown #9

nejm.org/doi/full/10.10…

⭐️⭐️ Is VDZ EFFECTIVE FOR TREATMENT OF CHRONIC POUCHITIS ⭐️⭐️

➡️➡️ Does it improve symptoms???
➡️➡️ Does it improve endoscopic appearance??
➡️➡️ Does it improve quality of life???

Full Review Coming Today!!!

Medical & dietetic management of the ileal pouch durig D-ECCO
workshops 🤩

Amazing lessons with amazing 🌟🌟from 🇮🇱 iris dotan & Lihi Godny 🫶🏻👌🏿🫶🏽

#diet 🥗
#microbiome 🦠
#dysbiosis 🔃
#antibootics 💊
#inflamation 🔥
and #pouchitis 😬

#ECCO2024 🇸🇪

Khoo - open label induction trial of TOFA in pts w chronic pouchitis (1/3 bio-IR) showing effectiveness in about 2/3 of patients after 8-16 weeks for both clinical & endoscopic endpoints. Maintenence withdrawal trial underway #DDW2024 #IBD

So What Is the Importance of the EARNEST Study?

Should we be more confident in prescribing Vedolizumab for patients with chronic antibiotic dependent and refractory pouchitis?

The Upshot: Not all high-quality evidence is of equally high quality....

Let's see why.....

New content online: Pouchitis: pathophysiology and management dlvr.it/T61Vqn

⭐️ New American Gastroenterological Association (AGA) guideline on pouchitis.

#Probiotics (De Simone formulation) are recommended for the prevention of recurrent pouchitis.

#MedTwitter #GITwitter #IBD #microbiome

gastrojournal.org/article/S0016-…

What do we do for #pouchitis when antibiotics fail? Richa Shukla gives a thorough review at the #BCMGICourse !
BCM Gastroenterology

The De Simone formulation #probiotic may not be cost effective for the primary prevention of pouchitis, but is cost effective for the prevention of recurrent pouchitis.

#MedTwitter #GITwitter #IBD #probiotic s #DDW2024

At this morning’s #DDW session about key challenges in #IBD , moderated by Dr. Marla Dubinsky, Maia Kayal MD addressed a full house, reminding all to seek balance in striving for complete remission with recognizing the value of incremental progress in the management of #pouchitis .

Results from the #SOCRATES study studying ustekinumab in #pouchitis during the last #DDW2023 poster tour!

#IBDHorizons23

Dr #BrianFeagan brings us what’s come about in the studies that took place in 2022/23

💉VDZ treating pouchitis
💊Upa for #UlcerativeColitis
💉Risa approval
💊Combo return of golmumab/guselkumab
💉TL1A monoclonal for fibrostenosing #Crohns