Antimicrobial Antibodies Are Associated With a Crohn's Disease–Like Phenotype After Ileal Pouch–Anal Anastomosis

TheNOD2insC polymorphism is associated with worse outcome following ileal pouch-anal anastomosis for ulcerative colitis

“…Patients who had undergone colectomy with IPAA at Mount Sinai Hospital (MSH), Cleveland Clinic and the Penn State Milton S Hershey Medical Center (HMC) were contacted by research staff between 2007 and 2010. The demographic and clinical features of subjects from MSH have been previously reported and described in detail,21 and the NOD2 genotype status has been previously reported for the HMC cohort 20. Any patients with a confirmed precolectomy diagnosis of UC and who had had their ileostomy closed a minimum of 1 year before study enrolment were included in the study.…”

Patchy colitis, and young age at diagnosis and at the time of surgery predict subsequent development of Crohn's disease after ileal pouch‐anal anastomosis surgery for ulcerative colitis

“…It has been hypothesized that it may be related to changes in bacterial flora following pouch creation, in association with underlying genetic susceptibility 2, 3, 5, 8. Some authors postulate that the formation of an anastomosis with the potential for fecal stasis above it creates an appropriate environment for the development of CD, analogous to the model of postoperative recurrence of CD at and proximal to an ileocolic anastmosis 2, 3, 12.…”

“…However, 5–13% of patients who have IPAA for UC subsequently develop clinical, radiological, or endoscopic changes that resemble Crohn's disease (CD) 3. These changes have been referred to as “CD of the pouch” or sometimes “Crohn's‐like” or “CD‐like” complications of the pouch 2, 4, 5, 6. Following IPAA, CD of the pouch can significantly reduce the quality of life.…”

“…Some potential factors that might help predict the subsequent development of CD in IPAA patients have been variably and sometimes inconsistently identified and these include seropositivity for anti‐CBir15, 6, 10 and anti‐ Saccharomyces cerevisiae antibody (ASCA),5, 6, 10, 11 a positive family history of CD,6, 12 preoperative presence of extraintestinal manifestations,13, 14 younger age,12, 13, 14, 15 smoking,5 preoperative diagnosis of indeterminate colitis,14, 16 and a longer duration after pouch surgery 12. In contrast, some studies have found no predictors for the postoperative development of CD on preoperative capsule endoscopy17 and on the histopathology of preoperative biopsies or colectomy specimens 4, 18…”

Frequency, Clinical Features and Factors Associated with Pouchitis after Proctocolectomy with Ileo-Pouch-Anal Anastomosis in Patients with Ulcerative Colitis: A Latin-American Country Retrospective-Cohort Study

“…Even though it leads to remission of disease in its intestinal expression, it also carries on several complications that drastically impact the patients' quality of life and bowel habits, especially at the beginning of the adaptation process. Some of the complications that may arise from this procedure are the anastomosis failure, pelvic sepsis [8,9], a 3 times higher infertility risk in young women [8,10], pelvic nerve damage, portal vein thrombosis [8,11], presence of fistulae, abscess, inflammation of the afferent limb, Crohn's disease of the pouch [12,13,14], the infrequent and auto-limited anal-transition zone dysplasia [7,15] and finally, one that has shown to have a frequency that varies from 12 to more than 50% [15,16,17,18], and thus the most common of all, pouchitis. This term refers to the inflammation of the ileal reservoir that appears de novo, whose multifactorial etiology, although still poorly understood, relies predominantly between immunologic and bacterial interactions [19], besides the fact that an autoimmune mechanism may be implicated in its pathogenesis, as it is frequently related to the presence of extra-intestinal manifestations (EIMs) and other diseases of immune origin [20].…”