Endoscopic and histologic evaluation together with symptom assessment are required to diagnose pouchitis.
OBJECTIVE
Pouchitis often is diagnosed based on symptoms alone. In this study, we evaluate whether symptoms correlate with endoscopic and histologic findings in patients with ulcerative colitis and an ileal pouch-anal anastomosis.


METHODS
Symptoms, endoscopy, and histology were assessed in 46 patients using Pouchitis Disease Activity Index (PDAI). Patients were classified as either having pouchitis (PDAI score > or =7; N = 22) or as not having pouchitis (PDAI score <7; N = 24).


RESULTS
Patients with pouchitis had significantly higher mean total PDAI scores, symptom scores, endoscopy scores, and histology scores. There was a similar magnitude of contribution of each component score to the total PDAI for the pouchitis group. Of note, 25% of patients with symptoms suggestive of pouchitis did not meet the PDAI diagnostic criteria for pouchitis. In both groups, the correlation coefficients between symptom, endoscopy, and histology scores were near zero (range, -0.26 to 0.20; P > 0.05).


CONCLUSIONS
The symptom, endoscopy, and histology scores each contribute to the PDAI and appear to be independent of each other. Symptoms alone do not reliably diagnose pouchitis.
Shen
B
B
Department of Gastroenterology, Center for Inflammatory Bowel Disease, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA. shenb@ccf.org.
Achkar
J P
JP
Lashner
B A
BA
Ormsby
A H
AH
Remzi
F H
FH
Bevins
C L
CL
Brzezinski
A
A
Petras
R E
RE
Fazio
V W
VW
D000328:Adult; D001706:Biopsy; D003093:Colitis, Ulcerative / Q000473:pathology; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology; D008297:Male; D008875:Middle Aged; D019449:Pouchitis / Q000473:pathology*