title: Preservation of the anal transition zone in ulcerative colitis. Long-term effects on defecatory function.
abstract: BACKGROUND
  The anal transition zone (ATZ) after ileal pouch anal anastomosis (IPAA) for ulcerative colitis is considered at risk for dysplasia and persistent or recurrent disease activity. The long-term fate of the ATZ and the effects of histologic changes on defecatory function are not well-known.
  
  
  METHODS
  To evaluate the inflammatory and preneoplastic changes of the ATZ in patients without preoperative dysplasia, yearly biopsies of the ATZ were obtained and functional results recorded on a questionnaire/diary. Histologic changes were correlated with simultaneous assessment of defecatory function.
  
  
  RESULTS
  Between 1992 and 2006, 225 patients underwent a stapled IPAA. A total of 238 successful biopsies of the ATZ were performed. There was no dysplasia found. Acute inflammation was noted in 4.6%, chronic inflammation in 84.9%, and normal mucosa in 10.5% of cases. Patients with chronic inflammation reported an average of 6.2+/-1.7 bowel movements/day and 93.2% of them were able to delay a bowel movement for at least 30 min. The presence of chronic ATZ inflammation did not seem to have a negative impact on function, with 96.1% of patients reporting perfect continence, and only 5.3% using protective pads.
  
  
  CONCLUSIONS
  Preservation of the ATZ in selected patients is safe and offers excellent long-term functional results. New onset dysplasia was not noted. Chronic inflammation had limited clinical impact. Presence of ATZ inflammation in a total of 89.5% of patients warrants life-long surveillance with biopsies.
authors: Department of Surgery, University of Chicago, Chicago, IL, USA. afichera@surgery.bsd.uchicago.edu
authors: Alessandro
authors: A
authors: Fichera
authors: Laura
authors: L
authors: Ragauskaite
authors: Mark T
authors: MT
authors: Silvestri
authors: Nicholas M
authors: NM
authors: Elisseou
authors: Michele A
authors: MA
authors: Rubin
authors: Roger D
authors: RD
authors: Hurst
authors: Fabrizio
authors: F
authors: Michelassi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000473:pathology*; D000714:Anastomosis, Surgical; D003093:Colitis, Ulcerative / Q000473:pathology* / Q000601:surgery; D039021:Colonic Pouches; D003672:Defecation / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D017792:Surgical Stapling; D013536:Suture Techniques