This document summarizes a journal club meeting on inflammatory disorders that can occur after restorative proctocolectomy with ileal pouch–anal anastomosis (IPAA). Pouchitis, Crohn's disease of the pouch, cuffitis, polyps, and extraintestinal manifestations are common inflammatory disorders. Acute pouchitis is usually treated with antibiotics, while chronic pouchitis may require biologics or anti-inflammatory therapies. Crohn's disease of the pouch is typically managed with biologics and endoscopic or surgical interventions for complications. The treatment of other disorders depends on their specific causes.

1. Kurdistan Board GEH/GIT Surgery J Club 2022
Supervised by Professor Dr. Mohamed Alshekhani.

2. Introduction:
 Restorative proctocolectomy with ileal pouch–anal anastomosis (IPAA) is
the preferred surgical treatment modality for patients with UC or FAP who
require colectomy & wish to avoid a permanent ileostomy.
 This surgical procedure improves the patient’s health-related QOL by
preserving the natural route of defecation, as compared with a permanent
ileostomy,but it is associated with various adverse sequelae, ranging from
structural complications to inflammatory conditions.
 The International Ileal Pouch Consortium has previously proposed a
diagnosis / classification system for ileal pouch disorders.
 Pouchitis is the most common long-term inflammatory condition of the
ileal pouch.
 Crohn’s disease or Crohn’s disease-like conditions, cuffitis& inflammatory
polyps can also occur in the ileal pouch,require medical therapy,sometimes
endoscopic or surgical intervention.

3. Pouch disorders:
 Pouchitis, Crohn’s disease of the pouch, cuffitis, polyps& extraintestinal
manifestations of IBD are common inflammatory disorders of the ileal
pouch.
 Acute pouchitis is treated with oral antibiotics & chronic pouchitis often
requires anti-inflammatory therapy, including the use of biologics.
 Aetiological factors for secondary pouchitis should be evaluated &
managed accordingly.
 Crohn’s disease of the pouch is usually treated with biologics&its
stricturing /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 & polyps in the cuff.
 The management principles of IBD EIMs in patients with pouches are
similar to those in patients without pouches.

21. Conclusion:
 Inflammatory disorders of the pouch are common in patients with ileal
pouches, particularly in those with underlying UC.
 Although acute pouchitis is mainly treated with oral antibiotics, CADP&
CARP require more intense strategies, including the use of biologics in
some patients.
 Causes of secondary pouchitis should be carefully evaluated/modified
accordingly.
 Biological therapy is the main treatment modality for Crohn’s disease of
the pouch, with adjunctive endoscopic&surgical therapy for fibrostenotic,
penetrating& perianal diseases.
 Topical anti-inflammatory agents are effective for classic cuffitis, a form of
remnant UC.
 Non-classic cuffitis is often associated with other aetiologies.
 Large, symptomatic inflammatory polyps& polyps at the cuff should be
endoscopically removed.

22. Conclusion:
 The principles of trt of EIMs in non-pouch IBD are also applicable to
patients with pouches.
 Pouchitis & other pouch disorders are not as prevalent as diabetes,
hypertension, or even Crohn’s disease / ulcerative colitis.
 The establishment of the International Ileal Pouch Consortium&
preparation of consensus guidelines is to meet the caring
gastroenterologists unmet need, for now.