Mistakes in pouchitis and how to avoid them

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Mistakes in pouchitis and how to avoid them

Ailsa L Hart, Susan K. Clark, Jonathan P Segal

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10

Lepistö A, Luukkonen P and Järvinen HJ. Cumulative failure rate of ileal pouch-anal anastomosis and quality of life after failure. Dis Colon Rectum 2002; 45: 1289–1294. [Link]

Sandborn WJ. Pouchitis: definition, risk factors, frequency, natural history, classification, and public health perspective. In: Sutherland LR, Mcleod RS, Noel Williams C, Martin F and Wallace JL (eds) Trends in Inflammatory Bowel Disease Therapy 1996. 1997; Springer Netherlands, 1997, p.51–63.

Pardi DS and Shen B. Endoscopy in the management of patients after ileal pouch surgery for ulcerative colitis. Endoscopy 2008; 40: 529–533. [Link]

Shen B. Pouchitis: What every gastroenterologist needs to know. Clin Gastroenterol Hepatol 2013; 11: 1538–1549. [Link]

Sandborn WJ, Tremaine WJ, Batts KP, et al. Pouchitis after ileal pouch-anal anastomosis: a pouchitis disease activity index. Mayo Clin Proc 1994; 69: 409–415. [Link]

Ben-Bassat O, Tyler AD, Xu W, et al. Ileal pouch symptoms do not correlate with inflammation of the pouch. Clin Gastroenterol Hepatol 2014; 12: 831–837.e2. [Link]

van der Ploeg V, Maeda Y, Faiz OD, et al. The prevalence of chronic peri-pouch sepsis in patients treated for antibiotic-dependent or refractory primary idiopathic pouchitis. Colorectal Dis 2017; 19: 827–831. [Link]

Navaneethan U and Shen B. Secondary pouchitis: Those with identifiable etiopathogenetic or triggering factors. Am J Gastroenterol 2010; 105: 51–64. [Link]

Segal JP, Ding NS, Worley G, et al. Systematic review with meta-analysis: the management of chronic refractory pouchitis with an evidence-based treatment algorithm. Aliment Pharmacol Ther 2017; 45: 581–592. [Link]

10.

Annerijn van der Ploeg V, Maeda Y, Faiz OD, et al. Standardising assessment and documentation of pouchoscopy. Frontline Gastroenterol 2018; 9: 309–314. [Link]

11.

Samaan MA, Shen B, Mosli MH, et al. Reliability among central readers in the evaluation of endoscopic disease activity in pouchitis. Gastrointest Endosc 2018; 88: 360–369.e2. [Link]

12.

Segal JP, Chan H, Collins B, et al. Biofeedback in patients with ileoanal pouch dysfunction: a specialist centre experience. Scand J Gastroenterol 2018; 53: 665–669. [Link]

13.

Shen B. Diagnosis and management of postoperative ileal pouch disorders. Clin Colon Rectal Surg 2010; 23: 259–268. [Link]

14.

Shen B, Lashner BA, Bennett AE, et al. Treatment of rectal cuff inflammation (cuffitis) in patients with ulcerative colitis following restorative proctocolectomy and ileal pouch-anal anastomosis. Am J Gastroenterol 2004; 99: 1527–1531. [Link]

15.

Thompson-Fawcett MW, Mortensen NJ, Warren BF. Cuffitis and inflammatory changes in the columnar cuff, anal transitional zone, and ileal reservoir after stapled pouch-anal anastomosis. Dis Colon Rectum 1999; 42: 348–355. [Link]

16.

Thompson JS. Cuffitis: A new cause of pouch dysfunction. Am J Gastroenterol 1999; 94: 2007. [Link]

17.

Wu B, Lian L, Li Y, et al. Clinical course of cuffitis in ulcerative colitis patients with restorative proctocolectomy and ileal pouch–anal anastomoses. Inflamm Bowel Dis 2013; 19: 404–410. [Link]

18.

Phillips RK. Ileal pouch-anal anastomosis for Crohn’s disease. Gut 1998; 43: 303–304. [Link]

19.

Hartley JE, Fazio VW, Remzi FH, et al. Analysis of the outcome of ileal pouch-anal anastomosis in patients with Crohn’s disease. Dis Colon Rectum 2004; 47: 1808–1815. [Link]

20.

Brown CJ, Maclean AR, Cohen Z, et al. Crohn’s disease and indeterminate colitis and the ileal pouch-anal anastomosis: outcomes and patterns of failure. Dis Colon Rectum 2005; 48: 1542–1549. [Link]

21.

Yu CS, Pemberton JH and Larson D. Ileal pouch-anal anastomosis in patients with indeterminate colitis: long-term results. Dis Colon Rectum 2000; 43: 1487–1496. [Link]

22.

Keighley MR. The final diagnosis in pouch patients for presumed ulcerative colitis may change to Crohn’s disease: patients should be warned of the consequences. Acta Chir Iugosl 2000; 47: 27–31. [Link]

23.

Gu J, Stocchi L, Kiran RP, et al. Do clinical characteristics of de novo pouch crohns disease after restorative proctocolectomy affect ileal pouch retention? Dis Colon Rectum 2014; 57: 76–82. [Link]

24.

Panis Y, Poupard B, Nemeth J, et al. Ileal pouch/anal anastomosis for Crohn’s disease. Lancet 1996; 347: 854–857. [Link]

25.

Regimbeau JM, Panis Y, Pocard M, et al. Long-term results of ileal pouch-anal anastomosis for colorectal Crohn’s disease. Dis Colon Rectum 2001; 44: 769–778. [Link]

26.

Bemelman WA, Warusavitarne J, Sampietro GM, et al. ECCO-ESCP consensus on surgery for crohn’s disease. J Crohn’s Colitis 2017; 12: 1–16. [Link]

27.

Deutsch AA, McLeod RS, Cullen J, et al. Results of the pelvic-pouch procedure in patients with Crohn’s disease. Dis Colon Rectum 1991;34:475–477. [Link]

28.

Grobler SP, Hosie KB and Keighley MRB. Randomized trial of loop ileostomy in restorative proctocolectomy. Br J Surg 1992; 79: 903–906. [Link]

29.

Hyman NH, Fazio VW, Tuckson WB, et al. Consequences of ileal pouch-anal anastomosis for Crohn’s colitis. Dis Colon Rectum 1991; 34: 653–657. [Link]

30.

Shen B, Fazio VW, Remzi FH, et al. Clinical features and quality of life in patients with different phenotypes of crohnʼs disease of the ileal pouch. Dis Colon Rectum 2007; 50: 1450–1459. [Link]

31.

Shen B, Fazio VW, Remzi FH, et al. Risk factors for clinical phenotypes of crohn’s disease of the ileal pouch. Am J Gastroenterol 2006; 101: 2760–2768. [Link]

32.

Wolf JM, Achkar J-P, Lashner BA, et al. Afferent limb ulcers predict Crohn’s disease in patients with ileal pouch-anal anastomosis. Gastroenterology 2004; 126: 1686–1691. [Link]

33.

Lightner AL, Fletcher JG, Pemberton JH, et al. Crohn’s disease of the pouch: A true diagnosis or an oversubscribed diagnosis of exclusion? Dis Colon Rectum 2017; 60: 1201–1208. [Link]

34.

Segal JP, Poo SX, McLaughlin SD, et al. Long-term follow-up of the use of maintenance antibiotic therapy for chronic antibiotic-dependent pouchitis. Frontline Gastroenterol 2018; 9: 154–158. [Link]

35.

Kim GK. The risk of fluoroquinolone-induced tendinopathy and tendon rupture: what does the clinician need to know? J Clin Aesthet Dermatol 2010; 3: 49–54. [Link]

36.

Goolsby TA, Jakeman B and Gaynes RP. Clinical relevance of metronidazole and peripheral neuropathy: a systematic review of the literature. Int J Antimicrob Agents 2018; 51: 319–325. [Link]

37.

Seril DN and Shen B. Clostridium difficile infection in patients with ileal pouches. Am J Gastroenterol 2014; 109: 941–947. [Link]

38.

Herfarth HH, Long MD and Isaacs KL. Use of biologics in pouchitis. J Clin Gastroenterol 2015; 49: 647–654. [Link]

39.

Weaver KN, Gregory M, Syal G, et al. Ustekinumab is effective for the treatment of crohn’s disease of the pouch in a multicenter cohort. Inflamm Bowel Dis 2019;25:767–774. [Link]

40.

Gregory M, Weaver KN, Hoversten P, et al. Efficacy of vedolizumab for refractory pouchitis of the ileo-anal pouch: results from a multicenter US cohort. Inflamm Bowel Dis 2019; 25: 1569–1576. [Link]

41.

‘Study to compare alicaforsen with placebo in patients with pouchitis’ NHS Health Research Authority https://www.hra.nhs.uk/planning-and-improving-research/application-summaries/research-summaries/study-to-compare-alicaforsen-with-placebo-in-patients-with-pouchitis/ (accessed April 2020). [Link]

42.

Godny L, Maharshak N, Reshef L, et al. Fruit consumption is associated with alterations in microbial composition and lower rates of pouchitis. J Crohn’s Colitis 2019; 13: 1265–1272. [Link]

43.

Ianco O, Tulchinsky H, Lusthaus M, et al. Diet of patients after pouch surgery may affect pouch inflammation. World J Gastroenterol 2013; 19: 6458. [Link]

44.

Kuisma J, Nuutinen H, Luukkonen P, et al. Long term metabolic consequences of ileal pouch-anal anastomosis for ulcerative colitis. Am J Gastroenterol 2001; 96: 3110–3116. [Link]

45.

Pastrana RJ, Torres EA, Arroyo JM, et al. Iron-deficiency anemia as presentation of pouchitis. J Clin Gastroenterol 2007; 41: 41–44. doi:10.1097/01.mcg.0000212641.90477.d0 [Link]

46.

Helavirta I, Huhtala H, Hyöty M, et al. Restorative proctocolectomy for ulcerative colitis in 1985–2009. Scand J Surg 2016; 105: 73–77. [Link]

Abstract

Topics

Small Intestine & Nutrition

Citation

Jonathan P Segal JP, Clark SK and Hart AL. Mistakes in pouchitis and how to avoid them. UEG Education 2020; 20: 7–11.

Published

2020

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UEG Standards and Guidelines

New

Clinical Practice Guideline

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Management of paediatric Crohn’s disease: an ECCO-ESPGHAN guideline update

Dror Shouval

Summary

AI Generated

Summary is not available for this content yet.

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Guideline

Abstract

Objective

To provide an updated, evidence-based European Crohn’s and Colitis Organisation [ECCO]–European Society for Paediatric Gastroenterology, Hepatology and Nutrition [ESPGHAN] guideline for the management, monitoring, and long-term care of pediatric Crohn’s disease [CD].

Methods

A multidisciplinary panel of 27 experts followed ECCO Standard Operating Procedures for guideline development. A systematic review of studies published between January 2018 and October 2024, with targeted updates through June 2025, was conducted across MEDLINE, EMBASE, and Cochrane Central. Evidence was graded using the Oxford Centre for Evidence-Based Medicine levels. Draft statements underwent two Delphi voting rounds involving the guideline panel, ECCO National Representatives, and an international sounding board; statements achieving ≥80% agreement were accepted.

Results

This guideline provides updated recommendations across major domains of pediatric CD care, including risk stratification, treatment targets, induction and maintenance strategies, nutritional therapies, therapeutic drug monitoring, and the roles of imaging and endoscopy. High-risk patients should start anti-TNF therapy as first-line treatment, with proactive and reactive therapeutic drug monitoring to enhance efficacy. For low-risk luminal disease, exclusive enteral nutrition or the Crohn’s Disease Exclusion Diet with partial enteral nutrition are preferred induction options. Long-term management emphasizes achieving endoscopic remission, normal growth, improved quality of life, and reduction of bowel damage. This guideline also reviews emerging advanced therapies, including biologics and small molecules, which are increasingly used in practice but generally not yet approved for pediatric CD, to inform clinicians about their potential role.

Conclusions

This updated ECCO–ESPGHAN guideline integrates new pediatric evidence with contemporary adult data and treat-to-target principles, providing practical recommendations to support personalized, multidisciplinary, and proactive management aimed at improving long-term outcomes in pediatric CD.

Publisher

European Crohn’s and Colitis Organisation

Guideline

Clinical Practice Guideline

Topics

IBD Paediatrics

Citation

Journal of Crohn's and Colitis, Volume 20, Issue 8, August 2026

Published

2026

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10

Lepistö A, Luukkonen P and Järvinen HJ. Cumulative failure rate of ileal pouch-anal anastomosis and quality of life after failure. Dis Colon Rectum 2002; 45: 1289–1294. [Link]

Pardi DS and Shen B. Endoscopy in the management of patients after ileal pouch surgery for ulcerative colitis. Endoscopy 2008; 40: 529–533. [Link]

Shen B. Pouchitis: What every gastroenterologist needs to know. Clin Gastroenterol Hepatol 2013; 11: 1538–1549. [Link]

Sandborn WJ, Tremaine WJ, Batts KP, et al. Pouchitis after ileal pouch-anal anastomosis: a pouchitis disease activity index. Mayo Clin Proc 1994; 69: 409–415. [Link]

Ben-Bassat O, Tyler AD, Xu W, et al. Ileal pouch symptoms do not correlate with inflammation of the pouch. Clin Gastroenterol Hepatol 2014; 12: 831–837.e2. [Link]

Navaneethan U and Shen B. Secondary pouchitis: Those with identifiable etiopathogenetic or triggering factors. Am J Gastroenterol 2010; 105: 51–64. [Link]

10.

Annerijn van der Ploeg V, Maeda Y, Faiz OD, et al. Standardising assessment and documentation of pouchoscopy. Frontline Gastroenterol 2018; 9: 309–314. [Link]

11.

Samaan MA, Shen B, Mosli MH, et al. Reliability among central readers in the evaluation of endoscopic disease activity in pouchitis. Gastrointest Endosc 2018; 88: 360–369.e2. [Link]

12.

Segal JP, Chan H, Collins B, et al. Biofeedback in patients with ileoanal pouch dysfunction: a specialist centre experience. Scand J Gastroenterol 2018; 53: 665–669. [Link]

13.

Shen B. Diagnosis and management of postoperative ileal pouch disorders. Clin Colon Rectal Surg 2010; 23: 259–268. [Link]

14.

15.

16.

Thompson JS. Cuffitis: A new cause of pouch dysfunction. Am J Gastroenterol 1999; 94: 2007. [Link]

17.

18.

Phillips RK. Ileal pouch-anal anastomosis for Crohn’s disease. Gut 1998; 43: 303–304. [Link]

19.

Hartley JE, Fazio VW, Remzi FH, et al. Analysis of the outcome of ileal pouch-anal anastomosis in patients with Crohn’s disease. Dis Colon Rectum 2004; 47: 1808–1815. [Link]

20.

21.

Yu CS, Pemberton JH and Larson D. Ileal pouch-anal anastomosis in patients with indeterminate colitis: long-term results. Dis Colon Rectum 2000; 43: 1487–1496. [Link]

22.

23.

24.

Panis Y, Poupard B, Nemeth J, et al. Ileal pouch/anal anastomosis for Crohn’s disease. Lancet 1996; 347: 854–857. [Link]

25.

Regimbeau JM, Panis Y, Pocard M, et al. Long-term results of ileal pouch-anal anastomosis for colorectal Crohn’s disease. Dis Colon Rectum 2001; 44: 769–778. [Link]

26.

Bemelman WA, Warusavitarne J, Sampietro GM, et al. ECCO-ESCP consensus on surgery for crohn’s disease. J Crohn’s Colitis 2017; 12: 1–16. [Link]

27.

Deutsch AA, McLeod RS, Cullen J, et al. Results of the pelvic-pouch procedure in patients with Crohn’s disease. Dis Colon Rectum 1991;34:475–477. [Link]

28.

Grobler SP, Hosie KB and Keighley MRB. Randomized trial of loop ileostomy in restorative proctocolectomy. Br J Surg 1992; 79: 903–906. [Link]

29.

Hyman NH, Fazio VW, Tuckson WB, et al. Consequences of ileal pouch-anal anastomosis for Crohn’s colitis. Dis Colon Rectum 1991; 34: 653–657. [Link]

30.

Shen B, Fazio VW, Remzi FH, et al. Clinical features and quality of life in patients with different phenotypes of crohnʼs disease of the ileal pouch. Dis Colon Rectum 2007; 50: 1450–1459. [Link]

31.

Shen B, Fazio VW, Remzi FH, et al. Risk factors for clinical phenotypes of crohn’s disease of the ileal pouch. Am J Gastroenterol 2006; 101: 2760–2768. [Link]

32.

Wolf JM, Achkar J-P, Lashner BA, et al. Afferent limb ulcers predict Crohn’s disease in patients with ileal pouch-anal anastomosis. Gastroenterology 2004; 126: 1686–1691. [Link]

33.

Lightner AL, Fletcher JG, Pemberton JH, et al. Crohn’s disease of the pouch: A true diagnosis or an oversubscribed diagnosis of exclusion? Dis Colon Rectum 2017; 60: 1201–1208. [Link]

34.

Segal JP, Poo SX, McLaughlin SD, et al. Long-term follow-up of the use of maintenance antibiotic therapy for chronic antibiotic-dependent pouchitis. Frontline Gastroenterol 2018; 9: 154–158. [Link]

35.

Kim GK. The risk of fluoroquinolone-induced tendinopathy and tendon rupture: what does the clinician need to know? J Clin Aesthet Dermatol 2010; 3: 49–54. [Link]

36.

Goolsby TA, Jakeman B and Gaynes RP. Clinical relevance of metronidazole and peripheral neuropathy: a systematic review of the literature. Int J Antimicrob Agents 2018; 51: 319–325. [Link]

37.

Seril DN and Shen B. Clostridium difficile infection in patients with ileal pouches. Am J Gastroenterol 2014; 109: 941–947. [Link]

38.

Herfarth HH, Long MD and Isaacs KL. Use of biologics in pouchitis. J Clin Gastroenterol 2015; 49: 647–654. [Link]

39.

Weaver KN, Gregory M, Syal G, et al. Ustekinumab is effective for the treatment of crohn’s disease of the pouch in a multicenter cohort. Inflamm Bowel Dis 2019;25:767–774. [Link]

40.

41.

42.

Godny L, Maharshak N, Reshef L, et al. Fruit consumption is associated with alterations in microbial composition and lower rates of pouchitis. J Crohn’s Colitis 2019; 13: 1265–1272. [Link]

43.

Ianco O, Tulchinsky H, Lusthaus M, et al. Diet of patients after pouch surgery may affect pouch inflammation. World J Gastroenterol 2013; 19: 6458. [Link]

44.

Kuisma J, Nuutinen H, Luukkonen P, et al. Long term metabolic consequences of ileal pouch-anal anastomosis for ulcerative colitis. Am J Gastroenterol 2001; 96: 3110–3116. [Link]

45.

Pastrana RJ, Torres EA, Arroyo JM, et al. Iron-deficiency anemia as presentation of pouchitis. J Clin Gastroenterol 2007; 41: 41–44. doi:10.1097/01.mcg.0000212641.90477.d0 [Link]

46.

Helavirta I, Huhtala H, Hyöty M, et al. Restorative proctocolectomy for ulcerative colitis in 1985–2009. Scand J Surg 2016; 105: 73–77. [Link]

Abstract

Indications include stenosis (oesophageal and colonic) and gastric outlet obstruction

Topics

Radiology & Imaging Surgery

Citation

Veld JV, Fockens P and van Hooft JE. Mistakes in enteral stenting and how to avoid them. UEG Education 2019; 19: 5–8

Published

2019

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10

Lepistö A, Luukkonen P and Järvinen HJ. Cumulative failure rate of ileal pouch-anal anastomosis and quality of life after failure. Dis Colon Rectum 2002; 45: 1289–1294. [Link]

Pardi DS and Shen B. Endoscopy in the management of patients after ileal pouch surgery for ulcerative colitis. Endoscopy 2008; 40: 529–533. [Link]

Shen B. Pouchitis: What every gastroenterologist needs to know. Clin Gastroenterol Hepatol 2013; 11: 1538–1549. [Link]

Sandborn WJ, Tremaine WJ, Batts KP, et al. Pouchitis after ileal pouch-anal anastomosis: a pouchitis disease activity index. Mayo Clin Proc 1994; 69: 409–415. [Link]

Ben-Bassat O, Tyler AD, Xu W, et al. Ileal pouch symptoms do not correlate with inflammation of the pouch. Clin Gastroenterol Hepatol 2014; 12: 831–837.e2. [Link]

Navaneethan U and Shen B. Secondary pouchitis: Those with identifiable etiopathogenetic or triggering factors. Am J Gastroenterol 2010; 105: 51–64. [Link]

10.

Annerijn van der Ploeg V, Maeda Y, Faiz OD, et al. Standardising assessment and documentation of pouchoscopy. Frontline Gastroenterol 2018; 9: 309–314. [Link]

11.

Samaan MA, Shen B, Mosli MH, et al. Reliability among central readers in the evaluation of endoscopic disease activity in pouchitis. Gastrointest Endosc 2018; 88: 360–369.e2. [Link]

12.

Segal JP, Chan H, Collins B, et al. Biofeedback in patients with ileoanal pouch dysfunction: a specialist centre experience. Scand J Gastroenterol 2018; 53: 665–669. [Link]

13.

Shen B. Diagnosis and management of postoperative ileal pouch disorders. Clin Colon Rectal Surg 2010; 23: 259–268. [Link]

14.

15.

16.

Thompson JS. Cuffitis: A new cause of pouch dysfunction. Am J Gastroenterol 1999; 94: 2007. [Link]

17.

18.

Phillips RK. Ileal pouch-anal anastomosis for Crohn’s disease. Gut 1998; 43: 303–304. [Link]

19.

Hartley JE, Fazio VW, Remzi FH, et al. Analysis of the outcome of ileal pouch-anal anastomosis in patients with Crohn’s disease. Dis Colon Rectum 2004; 47: 1808–1815. [Link]

20.

21.

Yu CS, Pemberton JH and Larson D. Ileal pouch-anal anastomosis in patients with indeterminate colitis: long-term results. Dis Colon Rectum 2000; 43: 1487–1496. [Link]

22.

23.

24.

Panis Y, Poupard B, Nemeth J, et al. Ileal pouch/anal anastomosis for Crohn’s disease. Lancet 1996; 347: 854–857. [Link]

25.

Regimbeau JM, Panis Y, Pocard M, et al. Long-term results of ileal pouch-anal anastomosis for colorectal Crohn’s disease. Dis Colon Rectum 2001; 44: 769–778. [Link]

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Abstract

Inflammatory bowel disease (IBD) is a chronic relapsing gastrointestinal disease, often affecting young people during their fertile years. The chronic character of IBD means that lifelong medical treatment is often required. As such, it is not surprising that questions often arise about fertility and pregnancy in patients with IBD. The most important risk factor for adverse pregnancy outcomes in IBD patients is the presence of disease activity during pregnancy. Indeed, negative pregnancy outcomes (e.g. spontaneous abortion, preterm delivery and low birth weight) are associated with disease activity at the time of conception and during pregnancy.

Topics

IBD Primary Care

Citation

Cite this article as: Kanis SL and van der Woude CJ. Mistakes in inflammatory bowel disease and reproduction and how to avoid them. UEG Education 2016: 16: 20–23.

Published

2024

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