title: Afferent limb ulcers predict Crohn's disease in patients with ileal pouch-anal anastomosis.
abstract: OBJECTIVE
  Some patients who undergo ileal pouch-anal anastomosis (IPAA) surgery for ulcerative colitis (UC) or indeterminate colitis are subsequently diagnosed with Crohn's disease (CD). Making the diagnosis of CD in patients with IPAA can be difficult, but it is important for prognostic and therapeutic purposes. The aim of this study was to identify diagnostic features of CD in patients with IPAA.
  
  
  METHODS
  We evaluated 87 patients who had undergone IPAA for inflammatory bowel disease. Patients were classified as having UC (n = 28), CD (n = 27), or indeterminate colitis (n = 32) based on review of the original colectomy pathology and the postoperative clinical course. Each patient underwent a pouch endoscopy with biopsies of the pouch and afferent limb. Both the endoscopist and pathologist were blinded to the patient's diagnosis.
  
  
  RESULTS
  Afferent limb ulcers (ALUs) were seen on endoscopy in 12 of 27 patients with CD (45%) and 4 of 28 patients with UC (14%) (P = 0.019). After excluding patients who had taken nonsteroidal anti-inflammatory drugs (NSAIDs) within the past month, ALUs were found in 7 of 18 patients with CD (39%) and 0 of 17 patients with UC (P = 0.010). Controlling for NSAID use and smoking, the odds ratio for ALUs indicating CD was 4.67 (P = 0.03). In the UC population, ALUs were seen in 4 of 11 patients (36%) who had taken NSAIDs in the past month and 0 of 17 patients who had not taken NSAIDs (P = 0.016).
  
  
  CONCLUSIONS
  ALUs seen on endoscopy are suggestive of CD in patients with inflammatory bowel disease who are not taking NSAIDs.
authors.affiliation: Department of Gastroenterology, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Wolf
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Achkar
authors.forename: Bret A
authors.initials: BA
authors.lastname: Lashner
authors.forename: Conor P
authors.initials: CP
authors.lastname: Delaney
authors.forename: Robert E
authors.initials: RE
authors.lastname: Petras
authors.forename: John R
authors.initials: JR
authors.lastname: Goldblum
authors.forename: Jason T
authors.initials: JT
authors.lastname: Connor
authors.forename: Feza H
authors.initials: FH
authors.lastname: Remzi
authors.forename: Victor W
authors.initials: VW
authors.lastname: Fazio
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000601:surgery; D003093:Colitis, Ulcerative / Q000473:pathology* / Q000601:surgery*; D039021:Colonic Pouches; D003424:Crohn Disease / Q000473:pathology* / Q000601:surgery*; D003937:Diagnosis, Differential; D016145:Endoscopy, Digestive System; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity