Serologic responses in indeterminate colitis patients before ileal pouch-anal anastomosis may determine those at risk for continuous pouch inflammation.
OBJECTIVE
Although acute pouchitis after ileal pouch-anal anastomosis is common and easily treated, continuous pouch inflammation seen clinically as chronic, antibiotic-dependent pouchitis, and/or Crohn's disease remains a difficult management problem. Compared with ulcerative colitis, indeterminate colitis patients undergoing ileal pouch-anal anastomosis have a higher incidence of continuous pouch inflammation, which may represent persistent immune reactivity to microbial antigens. Antibody responses to three microbial antigens (oligomannan anti-Saccharomyces cerevisiae, outer membrane porin C of Escherichia coli, and an antigen (I2) from Pseudomonas flourescens) are more commonly seen in Crohn's disease, whereas antibodies to a cross-reactive antigen (perinuclear antineutrophil cytoplasmic antibodies) is more suggestive of ulcerative colitis. We examined whether preoperative serologic responses to these antigens were associated with Crohn's disease in indeterminate colitis patients after ileal pouch-anal anastomosis.


METHODS
Twenty-eight indeterminate colitis patients undergoing ileal pouch-anal anastomosis were prospectively assessed for the development of pouchitis or Crohn's disease. Serologic responses were determined by enzyme-linked immunosorbent assay and immunofluorescence. Patients were classified based on four predominant profiles of antibody expression. Antibody profiles were determined before knowledge of clinical outcome.


RESULTS
Median follow-up was 38 (range, 3-75) months. Of 16 patients (61 percent) who developed pouch inflammation, 4 (25 percent) had acute pouchitis and 12 (75 percent) had continuous pouch inflammation (9 had chronic pouchitis, 3 had Crohn's disease). No preoperative clinical factor predicted the development of these pouch complications. Overall, 16 patients (57 percent) had a positive antibody reactivity profile. Serologic expression of any marker alone did not predict the development of continuous pouch inflammation. However, continuous pouch inflammation developed in 10 of 16 patients (63 percent) who had a positive antibody reactivity profile compared with only 2 of 12 patients (17 percent) who had a negative antibody reactivity profile (P = 0.015).


CONCLUSIONS
Indeterminate colitis patients who have a positive antibody reactivity profile before ileal pouch-anal anastomosis have a significantly higher incidence of continuous pouch inflammation after surgery than those with a negative profile.
Hui
Thomas
T
Division of Colon and Rectal Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Landers
Carol
C
Vasiliauskas
Eric
E
Abreu
Maria
M
Dubinsky
Marla
M
Papadakis
Konstantinos A
KA
Price
Joanne
J
Lin
Ying-Chao
YC
Huiying
Yang
Y
Targan
Stephan
S
Fleshner
Phillip
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000601:surgery; D000714:Anastomosis, Surgical / Q000009:adverse effects; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood*; D000908:Antibodies, Fungal / Q000097:blood*; D003092:Colitis / Q000097:blood* / Q000601:surgery; D039021:Colonic Pouches / Q000009:adverse effects; D003424:Crohn Disease / Q000097:blood / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018272:Porins / Q000097:blood*; D019449:Pouchitis / Q000097:blood / Q000209:etiology; D011237:Predictive Value of Tests; D016737:Proctocolectomy, Restorative / Q000009:adverse effects; D011446:Prospective Studies; D012307:Risk Factors; D012441:Saccharomyces cerevisiae / Q000276:immunology*; D018089:Superantigens / Q000097:blood*; D016896:Treatment Outcome
D019268:Antibodies, Antineutrophil Cytoplasmic; D000908:Antibodies, Fungal; C113724:OmpC protein; C469916:PfiT protein, Pseudomonas fluorescens; D018272:Porins; D018089:Superantigens