Treatment of pouchitis, Crohn's disease, cuffitis, and other inflammatory disorders of the pouch: consensus guidelines from the International Ileal Pouch Consortium

Lancet Gastroenterol Hepatol. 2021 Nov 10;S2468-1253(21)00214-4.doi: 10.1016/S2468-1253(21)00214-4. Online ahead of print.

Bo Shen 1Gursimran S Kochhar 2David T Rubin 3Sunanda V Kane 4Udayakumar Navaneethan 5Charles N Bernstein 6Raymond K Cross 7Akira Sugita 8Jason Schairer 9Ravi P Kiran 10Philip Fleshner 11James T McCormick 12André D'Hoore 13Samir A Shah 14Francis A Farraye 15Revital Kariv 16Xiuli Liu 17Joel Rosh 18Shannon Chang 19Ellen Scherl 20David A Schwartz 21Paulo Gustavo Kotze 22David H Bruining 4Jessica Philpott 23Bincy Abraham 24Jonathan Segal 25Rocio Sedano 26Maia Kayal 27Stuart Bentley-Hibbert 28Dino Tarabar 29Sandra El-Hachem 2Priya Sehgal 30Joseph A Picoraro 31Séverine Vermeire 32William J Sandborn 33Mark S Silverberg 34Darrell S Pardi 4


Author information

  • 1Center for Interventional Inflammatory Bowel Disease, Columbia University Irving Medical Center, NewYork Presbyterian Hospital, New York, NY, USA. Electronic address: bs3270@cumc.columbia.edu.
  • 2Division of Gastroenterology, Hepatology, and Nutrition, Allegheny Health Network, Pittsburgh, PA, USA.
  • 3University of Chicago Medicine Inflammatory Bowel Disease Center, Chicago, IL, USA.
  • 4Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
  • 5Center for IBD and Interventional IBD Unit, Digestive Health Institute, Orlando Health, Orlando, FL, USA.
  • 6Inflammatory Bowel Disease Clinical and Research Centre, University of Manitoba, Winnipeg, MB, Canada.
  • 7Inflammatory Bowel Disease Program, University of Maryland School of Medicine, Maryland, MD, USA.
  • 8Department of Clinical Research and Department of inflammatory Bowel Disease, Yokohama Municipal Citizens Hospital, Yokohama, Japan.
  • 9Department of Gastroenterology, Henry Ford Health System, Detroit, MI, USA.
  • 10Division of Colorectal Surgery, Columbia University Irving Medical Center, NewYork Presbyterian Hospital, New York, NY, USA.
  • 11Division of Colorectal Surgery, University of California-Cedars Sinai Medical Center, Los Angeles, CA, USA.
  • 12Division of Colon and Rectal Surgery, Allegheny Health Network, Pittsburgh, PA, USA.
  • 13Department of Abdominal Surgery, University Hospital Leuven, Leuven, Belgium.
  • 14Alpert Medical School of Brown University and Miriam Hospital, Gastroenterology Associates, Providence, RI, USA.
  • 15Division of Gastroenterology and Hepatology, Mayo Clinic Florida, Jacksonville, FL, USA.
  • 16Department of Gastroenterology, Tel Aviv Sourasky Medical Center and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
  • 17Department of Pathology, Immunology, and Laboratory Medicine, University of Florida, Gainsville, FL, USA.
  • 18Department of Pediatric Gastroenterology, Goryeb Children's Hospital/Atlantic Health, Morristown, NJ, USA.
  • 19Division of Gastroenterology, New York University Langone Health, New York, NY, USA.
  • 20Jill Roberts Center for IBD, Division of Gastroenterology and Hepatology, Weill Cornell Medicine, NewYork Presbytarian Hospital, New York, NY, USA.
  • 21Department of Gastroenterology, Vanderbilt University Medical Center, Nashville, TN, USA.
  • 22IBD Outpatients Clinic, Catholic University of Paraná, Curitiba, Brazil.
  • 23Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic, Cleveland, OH, USA.
  • 24Houston Methodist and Weill Cornell Medical College, Houston, TX, USA.
  • 25Department of Gastroenterology and Hepatology, Hillingdon Hospital, Uxbridge, UK.
  • 26Department of Medicine, Division of Gastroenterology, Western University, London, ON, Canada.
  • 27Department of Gastroenterology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA.
  • 28Department of Radiology, Columbia University Irving Medical Center, NewYork Presbyterian Hospital, New York, NY, USA.
  • 29IBD Clinical Center, University Hospital Center Dr Dragiša Mišovic, Belgrade, Serbia.
  • 30Division of Digestive and Liver Diseases, Columbia University Irving Medical Center, NewYork Presbyterian Hospital, New York, NY, USA.
  • 31Department of Pediatrics, Columbia University Irving Medical Center-Morgan Stanley Children's Hospital, New York, NY, USA.
  • 32Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium.
  • 33Department of Gastroenterology, University of California San Diego, San Diego, CA, USA.
  • 34Inflammatory Bowel Disease Centre, Mount Sinai Hospital, Toronto, ON, Canada.


Pouchitis, Crohn's disease of the pouch, cuffitis, polyps, and extraintestinal manifestations of inflammatory bowel disease are common inflammatory disorders of the ileal pouch. Acute pouchitis is treated with oral antibiotics and chronic pouchitis often requires anti-inflammatory therapy, including the use of biologics. Aetiological factors for secondary pouchitis should be evaluated and managed accordingly. Crohn's disease of the pouch is usually treated with biologics and its stricturing and fistulising complications can be treated with endoscopy or surgery. The underlying cause of cuffitis determines treatment strategies. Endoscopic polypectomy is recommended for large, symptomatic inflammatory polyps and polyps in the cuff. The management principles of extraintestinal manifestations of inflammatory bowel disease in patients with pouches are similar to those in patients without pouches.

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