P0317Unveiling Practice Patterns in Pouchitis Management: Results from a Global Survey

Abstract Background Pouchitis is the most frequent long-term complication after ileal pouch–anal anastomosis (IPAA) for ulcerative colitis. This survey aimed to describe current practices, definitions, and treatment strategies among experienced clinicians. Methods An international web-based survey was conducted in 2025, following CROSS guidelines, exploring diagnostic, monitoring, and therapeutic practices. Responses were anonymized and analyzed descriptively. Results A total of 412 physicians from 49 countries completed the survey, mostly gastroenterologist involved in IBD care (362/412, 87,8%). Most surveyed clinicians (156/412, 37.9%) estimated pouchitis prevalence between 26–50% of IPAA patients, typically occurring within the first postoperative year. Follow-up was reported to be scheduled every 3–6 months from 164/412 (39.8%) physicians, with 196/412 (47.6%) reporting the use of the disease activity index PDAI. Fecal calprotectin was selected as a non-invasive monitor strategy by 326/412 (79,1%) respondents, whereas intestinal ultrasound was selected by 130/412 (31.69%). Endoscopy was the primary diagnostic and follow-up tool (398/412, 96.6%), with biopsies routinely taken (364/412, 88%), although 46.7% reported not to apply any histologic scoring system. Regarding treatment, 222/412 (53.9%) prescribed prophylactic therapy, mainly probiotics (27.7%) and rectal mesalazine (18.2%). In acute pouchitis, ciprofloxacin plus metronidazole was the preferred first-line regimen (218/412, 52.9%) while for chronic antibiotic-dependent or refractory pouchitis, advanced therapies were the predominant first-line option (254/412, 61.7%), specifically with vedolizumab (198/412, 48.1%) and infliximab (170/412, 41.3%) selected as first-line strategies. When asked to order advanced therapy for pouchitis, anti-IL12/23, anti-IL-23, JAK inhibitors and S1P receptor modulators were progressively used in refractory disease. Selected treatment targets were mainly clinical (156/412, 37.9%) and endoscopic (124/412, 30,1%) remission, with most respondents (246/396, 62.1%) reporting endoscopic reassessment within 3–6 months of advanced treatment initiation. Conclusion This global survey reveals marked heterogeneity in diagnostic and therapeutic management of patients with pouchitis, underscoring the need for standardized definitions and algorithms, and further studies to optimize postoperative outcomes. Conflict of interest: D’Amico, Ferdinando: Grant: ECCO fellowship grant 2020 ECCO grant 2021 Personal Fees: F D’Amico has served as a speaker for Abbvie, Alfasigma, Ferring, Lilly, Sandoz, Janssen, Fresenius Kabi, Galapagos, Giuliani, MSD, Pfizer, Takeda, Tillotts, and Omega Pharma he also served as an advisory board member for Abbvie, AnaptysBio, Ferring, Fresenius Kabi, Galapagos, Janssen, Lilly, MSD, Takeda, and Nestlè. Fanizzi, Fabrizio: No conflict of interest Peyrin-Biroulet, Laurent: CONSULTING Abbvie, Abivax, Adacyte, Alimentiv, Alfasigma, Amgen, Apini, Banook, BMS, Celltrion, Enthera, Ferring, Fresenius Kabi, Galapagos, Genentech, Gilead, Iterative Health, Janssen, Lilly, LifeMine, Medac, Morphic, MSD, Nordic Pharma, Novartis, Oncodesign Precision Medicine, ONO Pharma, OSE Immunotherapeuthics, Par’ Immune, Pfizer, Prometheus, Roche, Roivant, Samsung, Sandoz, Sanofi, Sorriso, Spyre, Takeda, Teva, ThirtyfiveBio, Tillots, Vectivbio, Vedanta, Ventyx. LECTURE Abbvie, Alfasigma, Amgen, Biogen, Celltrion, Ferring, Galapagos, Genentech, Gilead, Iterative Health, Janssen, Lilly, Medac, MSD, Nordic Pharma, Pfizer, Sandoz, Takeda, Tillots Danese, Silvio: Personal Fees: AbbVie, Alimentiv, Allergan, Amgen, Applied Molecular Transport, AstraZeneca, Athos Therapeutics, Biogen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Celltrion, Dr Falk Pharma, Eli Lilly, Enthera, Ferring Pharmaceuticals Inc., Gilead, Hospira, Inotrem, Janssen, Johnson & Johnson, Morphic, MSD, Mundipharma, Mylan, Pfizer, Roche, Sandoz, Sublimity Therapeutics, Takeda, Teladoc Health, TiGenix, UCB Inc., Vial, Vifor Lecture fees from Abbvie, Amgen, Ferring Pharmaceuticals Inc., Gilead, Janssen, Mylan, Pfizer, Takeda