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

Bo Shen¹, Gursimran S Kochhar², David T Rubin³, Sunanda V Kane⁴, Udayakumar Navaneethan⁵, Charles N Bernstein⁶, Raymond K Cross⁷, Akira Sugita⁸, Jason Schairer⁹, Ravi P Kiran¹⁰, Philip Fleshner¹¹, James T McCormick¹², André D'Hoore¹³, Samir A Shah¹⁴, Francis A Farraye¹⁵, Revital Kariv¹⁶, Xiuli Liu¹⁷, Joel Rosh¹⁸, Shannon Chang¹⁹, Ellen Scherl²⁰, David A Schwartz²¹, Paulo Gustavo Kotze²², David H Bruining⁴, Jessica Philpott²³, Bincy Abraham²⁴, Jonathan Segal²⁵, Rocio Sedano²⁶, Maia Kayal²⁷, Stuart Bentley-Hibbert²⁸, Dino Tarabar²⁹, Sandra El-Hachem², Priya Sehgal³⁰, Joseph A Picoraro³¹, Séverine Vermeire³², William J Sandborn³³, Mark S Silverberg³⁴, Darrell S Pardi⁴

Affiliations

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

PMID: 34774224
DOI: 10.1016/S2468-1253(21)00214-4

Review

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

Bo Shen et al. Lancet Gastroenterol Hepatol. 2022 Jan.

. 2022 Jan;7(1):69-95.

doi: 10.1016/S2468-1253(21)00214-4. Epub 2021 Nov 10.

Authors

Affiliations

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

PMID: 34774224
DOI: 10.1016/S2468-1253(21)00214-4

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.

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Conflict of interest statement

Declaration of interests BA reports a research grant from Takeda and personal fees from Janssen, AbbVie, Pfizer, Samsung Biospis, Ferring, Bristol Myers Squibb. CNB reports grants and personal fees from AbbVie, Janssen, Pfizer, and Takeda, personal fees from Amgen, Bristol Myers Squibb, Roche, Sandoz, and Mylan Pharmaceuticals, and speaker fees from Medtronics. DHB reports grants from Medtronic and Takeda. RKC reports personal fees from AbbVie, Janssen, Samsung Bioepis, and Birstol Myers Squibb. FAF reports serving as an advisory board member for Bristol Myers Squibb, Braintree Labs, Gilead, GSK, Iterative Scopes, Janssen, Pfizer, and Sebela; owns stocks and shares in Innovation Pharmaceuticals; and is a member of Data Safety and Monitoring Boards for Lilly and Theravance. SVK reports grants from Gilead Sciences and TechLab. PGK reports personal fees from AbbVie, Janssen, Pfizer, Takeda, and Ferring, and grants from Pfizer and Takeda. JTM reports personal fees from Intuitive Surgical. UN reports grants and personal fees from Takeda, Janssen, and AbbVie, and personal fees from Pfizer. SE-H reports personal fees from AbbVie, Janssen, Takeda, UCB–Ferring, Pfizer, Bristol Myers Squibb, and Prometheus. JPh reports speaker fees from AbbVie. DTR reports personal fees from AbbVie, Abgenomics, Allergan, Arena Pharmaceuticals, Bellatrix Pharmaceuticals, Boehringer Ingelheim, Bristol Myers Squibb, CDx Diagnostics, Celgene/Syneos, Check-Cap, Dizal Pharmaceuticals, Galen Pharma/Atlantica, Genentech/Roche, Ichnos Sciences SA, InDex Pharmaceuticals, Iterative Scopes, Janssen, Lilly, Materia Prima, Marrow River Mgmt, Pfizer, Prometheus Laboratories, Reistone, Takeda, and TechLab. WJS reports grants, personal fees, and stock options from Prometheus Biosciences; grants and personal fees from AbbVie, Abivax, Alimentiv, Arena Pharmaceuticals, Boehringer-Ingelheim, Celgene, Genentech (Roche), Gilead Sciences, GlaxoSmithKline, Janssen, Lilly, Pfizer, Prometheus Biosciences, Seres Therapeutics, Shire, Surrozen, Takeda, and Theravance Biopharma; personal fees and stock options from Beigene, Gossamer Bio, Shoreline Bioscience, and personal fees from Allergan, AbbVie, Amgen, Applied Molecular Transport, Avexegen Therapeutics, Bausch Health, Beigene, Bellatrix Pharmaceuticals, Boston Pharmaceuticals, Bristol Myers Squibb, Celltrion, Cellularity, Conatus, Cosmo Pharmaceuticals, Escalier Biosciences, Ferring, Forbion, Equillium, Gilead, Glanmark Pharmaceuticals, Immunic, Incyte, Index Pharmaceuticals, Intact Therapeutics, Janssen, Kyowa Kirin Pharmaceutical Research, Kyverna Therapeutics, Landos Biopharma, Miraca Life Sciences, Nivalis Therapeutics, Novartis, Nutrition Science Partners, Oppilan Pharma, Pfizer, Progenity, Protagonist Therapeutics, Provention Bio, Reistone Biopharma, Ritter Pharmaceuticals, Shanghai Pharma Biotherapeutics, Sienna Biopharmaceuticals, Sigmoid Biotechnologies, Sterna Biologicals, Sublimity Therapeutics, Takeda, Thetis Pharmaceuticals, Tract, and UCB. ES reports grants and personal fees from AbbVie, Janssen, and Takeda, grants from AstraZeneca, Pfizer, and Genentech, and personal fees from Seres Health, Protagonist Therapeutics, Celgene, Entera Health, Bristol Myers Squibb, and Evidera. JSe reports speaker fees from Janssen and Takeda. DAS reports personal fees from AbbVie, Takeda, UCB, Jansen, Gilead, Pfizer, and Tract. SV reports consultancy fees and/or speaking fees from AbbVie, Arena Pharmaceuticals, Avaxia, Boehringer Ingelheim, Celgene, Dr Falk Pharma, Ferring, Galapagos, Genentech-Roche, Gilead, Hospira, Janssen, Mundipharma, Merck Sharpe & Dohme, Pfizer, Prodigest, Progenity, Prometheus, Robarts Clinical Trials, Second Genome, Shire, Takeda, Theravance, and Tillots Pharma AG, and grants from AbbVie, Johnson & Johnson, Pfizer, and Takeda. All other authors declare no competing interests.

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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

Publication types

MeSH terms

Substances

Grants and funding

LinkOut - more resources

Full Text Sources

Medical