Both preoperative perinuclear antineutrophil cytoplasmic antibody and anti-CBir1 expression in ulcerative colitis patients influence pouchitis development after ileal pouch-anal anastomosis.
OBJECTIVE
Acute pouchitis (AP) and chronic pouchitis (CP) are common after ileal pouch-anal anastomosis (IPAA) for ulcerative colitis. The aim of this study was to assess associations of preoperative perinuclear antineutrophil cytoplasmic antibody (pANCA) and anti-CBir1 flagellin on AP or CP development.


METHODS
Patients were assessed prospectively for clinically and endoscopically proven AP (antibiotic responsive) or CP (antibiotic-dependent or refractory to antibiotic therapy). Sera from 238 patients were analyzed for ANCA and anti-CBir1 using an enzyme-linked immunosorbent assay. pANCA(+) patients were substratified into high-level (>100 EU/mL) and low-level (<100 EU/mL) groups.


RESULTS
After a median follow-up period of 47 months, 72 patients (30%) developed pouchitis. Pouchitis developed in 36% of pANCA(+) patients versus 16% of pANCA(-) patients (P = .005), 46% of anti-CBir1(+) patients versus 26% of anti-CBir1(-) patients (P = .02), and 54% of 35 pANCA(+)/anti-CBir1(+) patients versus 31% of 136 pANCA(+)/anti-CBir1(-) patients (P = .02). AP developed in 37 pANCA(+) patients (22%) versus 6 pANCA(-) patients (9%) (P = .02), and 12 anti-CBir1(+) patients (26%) versus 31 anti-CBir1(-) patients (16%) (P = .1). Although AP was not influenced by pANCA level, AP was seen in 38% of low-level pANCA(+)/anti-CBir1(+) patients versus 18% low-level pANCA(+)/anti-CBir1(-) patients (P = .03). CP was seen in 29% of high-level pANCA(+) patients versus 11% of low-level pANCA(+) patients (P = .03).


CONCLUSIONS
Both pANCA and anti-CBir1 expression are associated with pouchitis after IPAA. Anti-CBir1 increases the incidence of AP only in patients who have low-level pANCA expression, and increases the incidence of CP only in patients who have high-level pANCA expression. Diverse patterns of reactivity to microbial antigens may manifest as different forms of pouchitis after IPAA.
Fleshner
Phillip
P
Division of Colon and Rectal Surgery, Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, California, USA. PFleshner@aol.com
Ippoliti
Andrew
A
Dubinsky
Marla
M
Vasiliauskas
Eric
E
Mei
Ling
L
Papadakis
Konstantinos A
KA
Rotter
Jerome I
JI
Landers
Carol
C
Targan
Stephan
S
D000208:Acute Disease; D000328:Adult; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood* / Q000276:immunology; D015415:Biomarkers / Q000097:blood; D002908:Chronic Disease; D003093:Colitis, Ulcerative / Q000097:blood* / Q000276:immunology / Q000601:surgery*; D039021:Colonic Pouches / Q000009:adverse effects / Q000276:immunology; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005408:Flagellin / Q000097:blood* / Q000276:immunology; D006801:Humans; D015994:Incidence; D008297:Male; D019449:Pouchitis / Q000453:epidemiology / Q000209:etiology* / Q000276:immunology; D011300:Preoperative Care; D016737:Proctocolectomy, Restorative / Q000009:adverse effects; D011379:Prognosis; D011446:Prospective Studies; D012016:Reference Values; D012680:Sensitivity and Specificity
D019268:Antibodies, Antineutrophil Cytoplasmic; D015415:Biomarkers; C502160:CBir1 flagellin; D005408:Flagellin