Immunoglobulin G and albumin levels in whole gut lavage fluid provide an objective measure of pouch ileitis.
BACKGROUND
Gut protein loss is a characteristic of inflammatory bowel disease (IBD), and immunoglobulin (Ig) G, albumin and alpha1-antitrypsin concentrations in whole gut lavage fluid (WGLF) correlate with clinical disease activity. If inflammation in ileoanal pouches is similar to IBD, then measurement of protein-losing enteropathy by analysis of WGLF may provide an objective assessment of disease activity in pouches.


METHODS
Forty-two patients who had restorative proctocolectomy for ulcerative colitis underwent whole gut lavage with a polyethylene glycol-electrolyte solution. The first clear effluent was filtered, processed by the addition of protease inhibitors and stored at - 70 degrees C. IgG, albumin and alpha1-antitrypsin were assayed in WGLF. The Pouchitis Disease Activity Index (PDAI) was calculated after pouchoscopy and biopsy; the Moskowitz criteria for pouchitis were also applied.


RESULTS
There was a significant correlation of the pouchoscopy score and the PDAI with the concentration of WGLF IgG. All patients with 'pouchitis' according to the Moskowitz criteria had a WGLF IgG concentration greater than 10 microg/ml. The WGLF albumin level also showed a significant correlation with the PDAI, but alpha1-antitrypsin concentration did not.


CONCLUSIONS
Analysis of WGLF for IgG and albumin may be useful in the assessment of disease activity in pouch inflammation.
Evgenikos
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Department of Surgery Western General Hospital and Royal Infirmary of Edinburgh, University of Edinburgh, UK.
Bartolo
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DC
Hamer-Hodges
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DW
Ghosh
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S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000418:Albumins / Q000032:analysis*; D003093:Colitis, Ulcerative / Q000601:surgery; D005260:Female; D005751:Gastric Lavage; D006801:Humans; D007079:Ileitis / Q000378:metabolism; D007074:Immunoglobulin G / Q000032:analysis*; D008297:Male; D008875:Middle Aged; D019449:Pouchitis / Q000378:metabolism*; D016737:Proctocolectomy, Restorative
D000418:Albumins; D007074:Immunoglobulin G