This phrase expresses a very strong dislike, stronger than just 'hate' alone. Ever since the betrayal, she hates his guts.
Pro Tip 2/3
Informal Context
Used in informal situations among friends or in dialogue within media, not in formal writing. I can't hang out with him, I hate his guts!
Pro Tip 3/3
Figure of Speech
It's an idiomatic expression, meaning don't take it literally; it does not involve actual guts. No, he doesn't hate your actual guts, it just means he's very angry with you.