Pouchitis in ulcerative colitis: correlation between predictors from colectomy specimens and clinico-histological features.
Pouchitis after restorative proctocolectomy for ulcerative colitis is usually of ill-defined etiology and is encountered with sclerosing cholangitis, bacterial overgrowth, and ischemia. Recently, appendiceal involvement, ileitis, and fissures in the colectomy specimen have been associated with short- and long-term development of pouchitis. To corroborate these recent findings, the histology of 40 colectomies (70% males; mean age 46.3 years, age range 20-70 years; mean follow-up period 3.7 years, range 1-13 years) with yearly follow-up biopsies was correlated with pouchitis and clinical symptoms. Appendicitis, fissures, and ileitis were present in 47, 45 and 5% of the patients, respectively. Pouchitis in patients with appendicitis or with fissures was noted in 44 and 50% at first biopsy and in 70 and 58% during follow-up (p = NS). Of the patients without appendicitis or without fissures, 33 and 33% demonstrated pouchitis at the first biopsy and 30 and 55% during follow-up (p = NS). Clinico-histological correlation revealed normal/near-normal biopsies with the lowest clinical severity score in 77% and with the highest clinical score in 43% (p < 0.025). The histological findings of appendiceal involvement, fissuring ulcers, and ileitis in colectomies for ulcerative colitis do not correlate with the finding of pouchitis in early or late pouch biopsies. A high clinical suspicion score is frequently not correlated with significant inflammation of the pouch.
Fogt
F
F
Department of Pathology, Presbyterian Medical Center, University of Pennsylvania, Philadelphia, PA 19104, USA. franz.fogt@uphs.upenn.edu
Deren
J J
JJ
Nusbaum
M
M
Wellmann
A
A
Ross
H M
HM
D000328:Adult; D000368:Aged; D003093:Colitis, Ulcerative / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D007422:Intestines / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D019449:Pouchitis / Q000473:pathology*; D016737:Proctocolectomy, Restorative / Q000009:adverse effects*; D012720:Severity of Illness Index