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.

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.


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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