Per Dr Hanauer. We need advanced therapies for treatment but we have limited access due to payer issues. We need steroid but even then our success at getting off is still not 💯 see below #AIBD2022
Expectation setting is key. @IBDMD recommends framing the maintenance phase of #IBD therapy as the prevention phase: preventing complications, preventing disease progression, and maintaining quality of life. Great panel discussion #AIBD2022@MLongMD@DrJessicaA@Marylandibddoc
Important point I learned at #AIBD2022 is that our medical dialogue with patients has changed. We should consider using terminology of Advanced Therapies (we have new oral agents) and not just saying Biologics! Our arsenal is growing. Very exciting? #AIBD2022
Therapy: biologic, do you need a dilation? Consider recycling therapy that was used prior to surgery for the pouch. There is some data however as said by Dr. Ungaro that if you treat with biologic patient was not previously exposed to May yield better long term outcome #AIBD2022
Stenosis in pouch inlet, inflammation in the pre pouch ileum not just pouch body inflammation and presence of fistula? This is more than chronic pouchitis. Please consider approach to orient in discussion! Consider terminology Crohn’s-like disease of the pouch. #AIBD2022
When is a pt refractory to antiobiotics for pouchitis? If you have cycled through 2-4 cycles they have CARP… time to move on treat inflammation and immune system. Think to treat with budesonide or biologic. #AIBD2022
Pouchitis Ab:
Cipro and flagyl and ok to cycle if needed. Together May not be well tolerated. Try it for 14 days. Another option: augmentin if pt can’t tolerate other meds.
#AIBD2022
Expert panelists. Differing thoughts. Evaluate endoscopically right away or just treat especially after first episode in first six months after surgery.
Acute pouchitis assess:
Check c.diff, check cal protectin, rule out infection.
If you ruled out infection start antibiotics but plan to scope as soon as you can, within a week if possible. #AIBD2022