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

Shen, Bo; Kochhar, Gursimran; Rubin, David T.; Kane, Sunanda V.; Navaneethan, Udayakumar; Bernstein, Çharles N.; Cross, Raymond K.; Sugita, Akira; Schairer, Jason; Kiran, Ravi P.; Fleshner, Philip; McCormick, James; D’Hoore, André; Shah, Samir A.; Farraye, Francis A.; Kariv, Revital; Liu, Xiuli; Rosh, Joel R.; Chang, Shannon; Scherl, Ellen; Schwartz, David A.; Kotze, Paulo Gustavo; Bruining, David H.; Philpott, Jessica; Abraham, Bincy; Segal, Jonathan; Sedaño, Rocío; Kayal, Maia; Bentley–Hibbert, Stuart; Tarabar, Dino; El‐Hachem, Sandra; Sehgal, Priya; Picoraro, Joseph A.; Vermeire, Séverine; Sandborn, William J.; Silverberg, Mark S.; Pardi, Darrell S.

doi:10.1016/s2468-1253(21)00214-4

Cited by 71 publications

(100 citation statements)

References 185 publications

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“…Although most of pouch polyps are inflammatory, polypectomy must be offered for pouch polyps exceeding 1 cm, for polyps The therapeutic strategy is outlined in Figure 3. Although most of pouch polyps are inflammatory, polypectomy must be offered for pouch polyps exceeding 1 cm, for polyps localised on the ATZ/rectal cuff and symptomatic inflammatory polyps [173,174]. Repeated biopsies within 6 months might be advisable in case of low-grade dysplasia.…”

Section: Endoscopic Monitoringmentioning

confidence: 99%

Incidence and Risk Factors of Cancer in the Anal Transitional Zone and Ileal Pouch following Surgery for Ulcerative Colitis and Familial Adenomatous Polyposis

Cosquer

Buscail

Gilletta

et al. 2022

Cancers

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Proctocolectomy with ileal pouch-anal anastomosis is the intervention of choice for ulcerative colitis and familial adenomatous polyposis requiring surgery. One of the long-term complications is pouch cancer, having a poor prognosis. The risk of high-grade dysplasia and cancer in the anal transitional zone and ileal pouch after 20 years is estimated to be 2 to 4.5% and 3 to 10% in ulcerative colitis and familial polyposis, respectively. The risk factors for ulcerative colitis are the presence of pre-operative dysplasia or cancer, disease duration > 10 years and severe villous atrophy. For familial polyposis, the risk factors are the number of pre-operative polyps > 1000, surgery with stapled anastomosis and the duration of follow-up. In the case of ulcerative colitis, a pouchoscopy should be performed annually if one of the following is present: dysplasia and cancer at surgery, primary sclerosing cholangitis, villous atrophy and active pouchitis (every 5 years without any of these factors). In the case of familial polyposis, endoscopy is recommended every year including chromoendoscopy. Even if anal transitional zone and ileal pouch cancers seldom occur following proctectomy for ulcerative colitis and familial adenomatous polyposis, the high mortality rate associated with this complication warrants endoscopic monitoring.

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Section: Endoscopic Monitoringmentioning

confidence: 99%

Incidence and Risk Factors of Cancer in the Anal Transitional Zone and Ileal Pouch following Surgery for Ulcerative Colitis and Familial Adenomatous Polyposis

Cosquer

Buscail

Gilletta

et al. 2022

Cancers

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“…38 The International Ileal Pouch Consortium mentions that attempts at endoscopic balloon dilation or stricturotomy should be made by trained endoscopists. 38 Several previous studies demonstrated that endoscopic balloon dilation is a safe and effective procedure to treat strictures (<4–5 cm) at the anastomosis, inlet, and afferent limb. 39–41 Endoscopic stricturotomy also serves as a useful procedure.…”

Section: Endoscopic Management Of Pouches With Cd-like Featuresmentioning

confidence: 99%

“…The International Ileal Pouch Consortium proposes that surgical strictureplasty, surgical resection and anastomosis, or bowel bypass surgery can effectively treat strictures located at the inlet, afferent limb, pouch body, or anastomosis when patients are refractory to repeat endoscopic therapy. 38 Surgical strictureplasty and endoscopic balloon dilation can be complimentary techniques for pouch strictures. While repeated endoscopic dilation is often needed, surgical strictureplasty may be associated with a longer time interval to stricture recurrence or pouch failure.…”

Section: Surgical Management Of Pouches With Cd-like Featuresmentioning

confidence: 99%

Diagnostic and Management Considerations for the IPAA With Crohn’s Disease-Like Features

Akiyama

Dyer

Rubin

2022

Diseases of the Colon &Amp; Rectum

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BACKGROUND: Patients with ulcerative colitis often develop medically refractory colonic inflammation or colorectal neoplasia, and approximately 10% to 15% of patients require surgery. The most common surgical procedure is a restorative proctocolectomy with IPAA. Even if the preoperative diagnosis is ulcerative colitis, approximately 10% of patients can develop inflammatory pouch conditions resembling a Crohn’s disease phenotype. OBJECTIVE: This study aimed to review the diagnostic approach, prognosis, and management of IPAA with Crohn's disease–like features. DATA SOURCES: The data sources include search in electronic databases. STUDY SELECTION: This narrative review included studies focusing on pouches with Crohn's disease–like features. MAIN OUTCOME MEASURES: The main topics in this review included the pathogenesis, risk factors, diagnosis, phenotypes, prognosis, and medications of pouches with Crohn's disease–like features. RESULTS: A diagnostic approach for the pouch conditions resembling a Crohn's disease phenotype should be based on history–taking to evaluate its risk factors and endoscopic assessment of the pouch. Prior disease history and pathology, location of pouch complications, and timing of complications offer clues for the differential diagnosis of this phenotype. We advocate for the more descriptive term “pouch with Crohn's disease–like features” and reserve the term “Crohn's disease of the pouch” for patients who undergo IPAA and have a precolectomy diagnosis of Crohn's disease or whose colectomy pathology revealed Crohn's disease. Medications, which are often used for traditional Crohn's disease, show efficacy in pouches with Crohn's disease–like features as well. The poor prognosis associated with pouches with Crohn's disease–like features, particularly the fistulizing phenotype, underscores the importance of proactive monitoring and therapeutic intervention. LIMITATIONS: The limitations include no explicit criteria for article selection. CONCLUSIONS: This review suggests future research should seek to understand the natural history and meaningful shorter and longer term therapeutic targets for these types of pouch phenotypes. Long-term follow-up and prospective preoperative and postoperative interventional trials of treatments and prevention strategies are needed.

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“…Antibiotics represent the mainstay for the treatment of pouchitis [63] as they can induce remission by 74% in chronic pouchitis [64]. Ciprofloxacin and metronidazole are the first-line recommended antibiotics, although the best modality of treatment is still unclear [65].…”

Section: Antibioticsmentioning

confidence: 99%

Ileal Pouch–Anal Anastomosis and Pouchitis: The Role of the Microbiota in the Pathogenesis and Therapy

et al. 2022

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Inflammatory bowel diseases, Crohn’s disease and ulcerative colitis, are life-long disorders characterized by the chronic relapsing inflammation of the gastrointestinal tract with the intermittent need for escalation treatment and, eventually, even surgery. The total proctocolectomy with ileal pouch–anal anastomosis (IPAA) is the surgical intervention of choice in subjects affected by ulcerative colitis (UC). Although IPAA provides satisfactory functional outcomes, it can be susceptible to some complications, including pouchitis as the most common. Furthermore, 10–20% of the pouchitis may develop into chronic pouchitis. The etiology of pouchitis is mostly unclear. However, the efficacy of antibiotics in pouchitis suggests that the dysbiosis of the IPAA microbiota plays an important role in its pathogenesis. We aimed to review the role of the microbiota in the pathogenesis and as a target therapy in subjects who develop pouchitis after undergoing the surgical intervention of total proctocolectomy with IPAA reconstruction.

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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

Cited by 71 publications

References 185 publications

Incidence and Risk Factors of Cancer in the Anal Transitional Zone and Ileal Pouch following Surgery for Ulcerative Colitis and Familial Adenomatous Polyposis

Incidence and Risk Factors of Cancer in the Anal Transitional Zone and Ileal Pouch following Surgery for Ulcerative Colitis and Familial Adenomatous Polyposis

Diagnostic and Management Considerations for the IPAA With Crohn’s Disease-Like Features

Ileal Pouch–Anal Anastomosis and Pouchitis: The Role of the Microbiota in the Pathogenesis and Therapy

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