Pipe flow responds to strong perturbations in ways that are fundamentally different from the response exhibited by boundary layers undergoing a similar perturbation, primarily because of the confinement offered by the pipe wall, and the need to satisfy continuity. We review such differences by examining previous literature, with a particular focus on the response of pipe flow to three different kinds of disturbances: the abrupt change in surface condition from rough to smooth, the obstruction due to presence of a single square bar roughness elements of different sizes, and the flow downstream of a streamlined body-of-revolution placed on the centerline of the pipe. In each case, the initial response is strongly influenced by the pipe geometry, but far downstream all three flows display a common feature, which is the very slow, second-order recovery that can be explained using a model based on the Reynolds stress equations. Some future directions for research are also given.