title: Antineutrophil cytoplasmic antibody subtypes in children and adolescents after ileal pouch-anal anastomosis for ulcerative colitis.
abstract: BACKGROUND
  Perinuclear antineutrophil cytoplasmic antibodies occur frequently in adult patients with chronic pouchitis after colectomy and ileal pouch-anal anastomosis for ulcerative colitis. The purpose of the study was to determine the prevalence of perinuclear antineutrophil cytoplasmic antibodies and cytoplasmic antineutrophil cytoplasmic antibody in children and adolescents who undergo colectomy and ileal pouch-anal anastomosis for ulcerative colitis and familial adenomatous polyposis.
  
  
  METHODS
  Five groups of children and adolescents (age, <20 years) were studied, with the following histories: acute pouchitis and history of ulcerative colitis; chronic pouchitis and history of ulcerative colitis; pouchitis with Crohn's disease features and a history of ulcerative colitis; no pouchitis and a history of ulcerative colitis; and familial adenomatous polyposis, with or without pouchitis. Antineutrophil cytoplasmic antibody levels and titers were detected in postoperative sera by enzyme-linked immunosorbent assay, and positive results were subtyped by indirect immunofluorescence.
  
  
  RESULTS
  The frequency of perinuclear antineutrophil cytoplasmic antibodies and cytoplasmic antineutrophil cytoplasmic antibody in patients with a history of ulcerative colitis were 67% and 15%, compared with a 0% presence in patients with familial adenomatous polyposis (p < 0.001). There was no significant correlation between the frequency of perinuclear antineutrophil cytoplasmic antibodies and ulcerative colitis patient subgroups (patients with and without pouchitis, 66% and 75%). Similarly, there was no significant correlation between the frequency of cytoplasmic antineutrophil cytoplasmic antibodies among ulcerative colitis patient subgroups (patients with and without pouchitis, 19% and 8%). The frequency of cytoplasmic antineutrophil cytoplasmic antibody in patients with Crohn's disease features (50%), was increased, but this difference was not significant.
  
  
  CONCLUSIONS
  There is a high frequency of perinuclear antineutrophil cytoplasmic antibodies in children and adolescents who undergo ileal pouch-anal anastomosis for ulcerative colitis, whether or not they have pouchitis. The frequency of cytoplasmic antineutrophil cytoplasmic antibody is lower in this patient population. Additional studies will be required to determine whether the presence of cytoplasmic antineutrophil cytoplasmic antibody is associated with the postoperative development of features of Crohn's disease.
authors.affiliation: Division of Pediatric Gastroenterology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
authors.forename: A G
authors.initials: AG
authors.lastname: Kaditis
authors.forename: J
authors.initials: J
authors.lastname: Perrault
authors.forename: W J
authors.initials: WJ
authors.lastname: Sandborn
authors.forename: C J
authors.initials: CJ
authors.lastname: Landers
authors.forename: A R
authors.initials: AR
authors.lastname: Zinsmeister
authors.forename: S R
authors.initials: SR
authors.lastname: Targan
mesh_terms: D011125:Adenomatous Polyposis Coli / Q000276:immunology / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood* / Q000145:classification; D002648:Child; D002675:Child, Preschool; D003093:Colitis, Ulcerative / Q000276:immunology* / Q000601:surgery*; D004797:Enzyme-Linked Immunosorbent Assay; D019084:Fluorescent Antibody Technique, Indirect; D006801:Humans; D007079:Ileitis / Q000209:etiology / Q000276:immunology / Q000601:surgery; D016737:Proctocolectomy, Restorative / Q000009:adverse effects
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic