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How to Manage Pouchitis: a Consensus Guideline From Global Pouch Consortium

Gursimran S. Kochhar, MD reviewing Shen B, et al. Lancet Gastroenterol Hepatol 2022 Jan.

Pouchitis and other diseases of the ileal pouch, also known as the J pouch, have always been very challenging to manage. The lack of large randomized controlled trials has added to the dilemma of treating pouchitis and other associated diseases. The International Ileal Pouch Consortium recently published consensus guidelines to help physicians treat pouchitis. A steering committee performed a thorough review of the literature and created statements, and then, a group of more than 30 international experts participated in the Delphi process and voted for these guideline statements.

The authors recommend that the initial episode of pouchitis be managed with antibiotics such as ciprofloxacin and metronidazole. Topical budesonide should be considered second-line therapy. For chronic antibiotic-refractory pouchitis, vedolizumab is preferred over anti-tumor necrosis factor agents. The failure of a specific agent before J-pouch surgery should not preclude its use. Some patients may need long-term suppressive antibiotics to manage their pouchitis.


Pouchitis and other inflammatory conditions of the J pouch can be difficult to diagnose and treat. These consensus guidelines will help clinicians to treat these challenging conditions more effectively. The guidelines also highlight the critical areas in which further research is necessary, as most of the statements are based on anecdotal experience and not on large randomized clinical trials.

Gursimran S. Kochhar, MD

Bio and Disclosures


Shen B, Kochhar GS, Rubin DT, et al. Treatment of pouchitis, Crohn’s disease, cuffitis, and other inflammatory bowel disorders of the pouch: consensus guidelines from the International Ileal Pouch Consortium. Lancet Gastroenterol Hepatol 2022;7:69-95. (