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

Abstract

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.