Histologic Predictors of Pouchitis in Patients with Chronic Ulcerative Colitis

Abstract

Inflammation of ileal reservoir mucosa ("pouchitis") is a common sequelae in ulcerative colitis (UC) patients who have had a colectomy with ileal pouch anal-anastomosis (IPAA). Although several clinical, genetic, and laboratory parameters have been evaluated, reliable pathologic predictors for the development of pouchitis are lacking. The purpose of this case-control study was to determine whether there are any pathologic features in UC colectomy specimens that may help predict the subsequent development of pouchitis after an IPAA procedure. The study group consisted of 39 UC patients (male/female ratio: 21/18, mean age: 35 years), who had at least 1 episode of pouchitis after an IPAA procedure during the follow-up period (mean: 57 months, range: 12-121 months). There were 26 control patients (male/female ratio: 11/15, mean age: 37 years), all of whom also underwent a total colectomy and IPAA procedure for UC, but did not develop pouchitis during the follow-up period (mean: 78 months, range: 14-223 months). Routinely processed tissues from each colectomy specimen were evaluated for a variety of histologic features, such as extent of colitis, severity of colitis, extent of severe colitis, type and extent of ulceration, presence and severity of appendiceal inflammation, and the presence of active ileitis, and compared between the study and control patients. Pathologic features that were associated with the subsequent development of pouchitis included the presence of severe colitis that extended into the cecum (severe pancolitis), which was present in 7/39 (18%) pouchitis patients, but in none (0%) of the control patients (P = 0.03), early fissuring ulcers [9/39 (23%) pouchitis cases versus 1/26 (4%) controls (P = 0.04)], active inflammation of the appendix [20/32 (63%) pouchitis patients versus 7/19 (31%) controls (P = 0.03)], and appendiceal ulceration [13/32 (41%) pouchitis patients versus none (0%) of the controls (P = 0.002)]. No significant differences in patient gender or age, depth or extent of ulceration, or the presence or absence of "backwash ileitis" were identified between the 2 groups. In conclusion, there are several histologic features in colectomy specimens from UC patients who have undergone an IPAA procedure that may help predict the subsequent development of pouchitis. Of these features, appendiceal ulceration is highly associated with pouchitis.

Mucosal function in rat jejunum and ileum is altered by induction of colitis

“…When the entire colon is involved, UC can extend a variable distance into the terminal ileum in a phenomenon known as backwash ileitis (BWI) (7). BWI develops as a result of reflux of colonic contents into the ileum due to an incompetent or poorly functioning, and inflamed ileocecal valve (8), and features focal neutrophilic infiltrates of the superficial crypts and surface epithelium (9).…”

Pouchitis in Ulcerative Colitis: Correlation between Predictors from Colectomy Specimens and Clinico-Histological Features

“…specific features within the colectomy specimen, specifically involvement of the appendix by UC and the presence of fissuring ulcers or ileitis [5,6] . Clinical scoring systems have been put in place to predict the presence of pouchitis, with different predictive values and validity [7][8][9][10][11] .…”

Ileitis tras ileostomía

“…Se hipotetiza que es debido a importantes cambios de los mediadores de la infl amación tras la colectomía, de la buena respuesta que presenta al tratamiento esteroideo. El éxtasis fecal, el sobrecrecimiento bacteriano, alteraciones inmunológicas, la toxicidad de los ácidos biliares, defi ciencia de ácidos grasos de cadena corta e isquemia también se han descrito como posibles factores implicados en su etiopatogenia [3][4][5] . Se clasifi ca en aguda o crónica dependiendo del momento de aparición, días o semanas tras la creación del estoma en la aguda y meses o años en la crónica.…”