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. 2022 Jan;7(1):69-95. doi: 10.1016/S2468-1253(21)00214-4. Epub 2021 Nov 10.


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.

Publication types

  • Practice Guideline
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Acute Disease
  • Anti-Bacterial Agents / therapeutic use*
  • Anti-Inflammatory Agents / therapeutic use*
  • Biological Products / therapeutic use
  • Chronic Disease
  • Colonic Pouches / adverse effects*
  • Consensus
  • Constriction, Pathologic / etiology
  • Constriction, Pathologic / therapy
  • Crohn Disease / complications
  • Crohn Disease / drug therapy*
  • Crohn Disease / prevention & control
  • Crohn Disease / surgery
  • Cutaneous Fistula / therapy
  • Gastrointestinal Agents / therapeutic use*
  • Humans
  • Intestinal Fistula / therapy
  • Intestinal Polyps / surgery
  • Maintenance Chemotherapy
  • Pouchitis / drug therapy*
  • Pouchitis / etiology
  • Pouchitis / prevention & control
  • Pouchitis / surgery
  • Recurrence
  • Risk Factors
  • Secondary Prevention / methods
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors


  • Anti-Bacterial Agents
  • Anti-Inflammatory Agents
  • Biological Products
  • Gastrointestinal Agents
  • Tumor Necrosis Factor-alpha