Colonic Histological Criteria Predict Development of Pouchitis after Ileal Pouch: Anal Anastomosis for Patients with Ulcerative Colitis

Abstract

Background/Aims: Pouchitis is one of the main complications after ileal pouch-anal anastomosis in patients with ulcerative colitis. The aim of this study was to determine whether the use of colonic histological criteria can predict the development of pouchitis. Methodology: We retrospectively reviewed 147 patients' clinical data and performed a histological evaluation of the resected total colon using Tanaka's criteria, which comprise the following 6 factors: ulceration (H₁), crypt abscesses (H₂), degree of mononuclear cell infiltration (MNCI) (H₃), segmental distribution of MNCI (H₄), eosinophil infiltration (H₅), and extent of disease of resected colon (H₆). Results: The development of pouchitis and chronic pouchitis within 3 years after restoration of gastrointestinal continuity was recognized in 52 (35.4%) and 26 (17.7%) of the 147 patients, respectively. Using various combinations of each score, the H₃ + H₄ - H₅ scores of patients with pouchitis or chronic pouchitis were significantly higher than those of patients without. A H₃ + H₄ - H₅ score of >0.4 was a statistically significant risk factor for the development of both pouchitis and chronic pouchitis. Conclusions: The combination of the degree of MNCI, segmental distribution of MNCI, and eosinophil infiltration from histological criteria has utility in predicting the future development of pouchitis, especially chronic pouchitis.

Microbiota DNA Translocation into Mesentery Lymph Nodes Is Associated with Early Development of Pouchitis after IPAA for Ulcerative Colitis

“…In previous studies, attempts have been made to predict pouchitis using different parameters. These include genetic profiling, 30,31 perioperative characteristics, 32,33 and histological valuation, 34 most of which were with poor performance or underpowered. Another study identified increased proportions of Fusobacteriaceae and reduced proportions of Faecalibacterium in fecal samples of patients with pouch inflammation, but research focusing on the relationship between BT and pouchitis is still lacking.…”

Astragaloside IV alleviates the symptoms of experimental ulcerative colitis in vitro and in vivo

“…A BH22 light microscope (Olympus Corporation; magnification, ×400) was used to observe the histological damage and inflammation of the colon tissues. Severity of histological inflammation was graded as described previously (23,24): Ulceration (0, none; 1, erosion; 2, submucosa ulceration); crypt abscesses (0, none; 1, mild; 2, severe), degree of mononuclear cell infiltration (MNCI) (0, no infiltration; 1, <25%; 2, 25–50%; 3, 50–75%; 4, >75%); segmental distribution of MNCI (0, continuous; 1, mildly segmental; 2, markedly segmental); and eosinophil infiltration (0, none or minimal; 1, mild; 2, severe).…”

Pouchitis in inflammatory bowel disease: a review of diagnosis, prognosis, and treatment

“…50,51 Antineutrophil cytoplasmic antibody (ANCA) 52 A meta-analysis showed the risk of chronic pouchitis was higher in ANCA-positive patients, but the risk of acute pouchitis was unaffected by ANCA status. 52 Histologic findings of colectomy samples 53 The combination of the degree of mononuclear cell infiltration (MNCI), segmental distribution of MNCI, and eosinophil infiltration in the resected total colon had a utility to predict the development of chronic pouchitis. 53 3-Stage ileal pouch-anal anastomosis (IPAA) 54 A multicenter, retrospective cohort study of pouchitis in pediatric ulcerative colitis showed that 3-stage IPAA may increase the risk of pouchitis.…”

“…52 Histologic findings of colectomy samples 53 The combination of the degree of mononuclear cell infiltration (MNCI), segmental distribution of MNCI, and eosinophil infiltration in the resected total colon had a utility to predict the development of chronic pouchitis. 53 3-Stage ileal pouch-anal anastomosis (IPAA) 54 A multicenter, retrospective cohort study of pouchitis in pediatric ulcerative colitis showed that 3-stage IPAA may increase the risk of pouchitis. 54 Nonsteroidal anti-inflammatory drugs (NSAIDs) 46,49 NSAIDs was reported to increase the risk of pouchitis.…”

“…Extensive colitis, 44,49 male sex, 50,51 ANCA (antineutrophil cytoplasmic antibody), 52 histologic findings of colectomy samples, 53 3-stage IPAA, 54 and nonsteroidal anti-inflammatory drugs 46,49 are other possible risk factors of pouchitis (Table 2).…”