title: Ileal lesions in patients with ulcerative colitis after ileo-rectal anastomosis: relationship with colonic metaplasia.
abstract: OBJECTIVE
  To assess whether in ulcerative colitis (UC) patients with ileo-rectal anastomosis (IRA), ileal lesions may develop in the neo-terminal-ileum and their possible relation with phenotypic changes towards colonic epithelium.
  
  
  METHODS
  A total of 19 patients with IRA under regular follow up were enrolled, including 11 UC and 8 controls (6 Crohn's disease, CD; 1 familial adenomatous polyposis, FAP; 1 colon cancer, colon K). Ileal lesions were identified by ileoscopy with biopsies taken from the ileum (involved and uninvolved) and from the rectal stump. Staining included HE and immunohistochemistry using monoclonal antibodies against colonic epithelial protein CEP (Das-1) and human tropomyosin isoform 5, hTM5 (CG3). Possible relation between development of colonic metaplasia and ileal lesions was investigated.
  
  
  RESULTS
  Stenosing adenocarcinoma of the rectal stump was detected in 1 UC patient. The neo-terminal ileum was therefore investigated in 10/11 UC patients. Ileal ulcers were detected in 7/10 UC, associated with colonic metaplasia in 4/7 (57.1%) and Das-1 and CG3 reactivity in 3/4 UC. In controls, recurrence occurred in 4/6 CD, associated with colonic metaplasia in 3/4 and reactivity with Das-1 and CG3 in 2/3.
  
  
  CONCLUSIONS
  Present findings suggest that in UC, ileal lesions associated with changes towards colonic epithelium may develop also after IRA. Changes of the ileal content after colectomy may contribute to the development of colonic metaplasia, leading to ileal lesions both in the pouch and in the neo-terminal ileum after IRA.
authors.affiliation: Cattedra di Gastroenterologia, Dipartimento di Medicina Interna, Universita "Tor Vergata", Via Montpellier 1, Rome 00133, Italy. biancone@med.uniroma2.it
authors.forename: Livia
authors.initials: L
authors.lastname: Biancone
authors.forename: Emma
authors.initials: E
authors.lastname: Calabrese
authors.forename: Giampiero
authors.initials: G
authors.lastname: Palmieri
authors.forename: Carmelina
authors.initials: C
authors.lastname: Petruzziello
authors.forename: Sara
authors.initials: S
authors.lastname: Onali
authors.forename: Giuseppe-Sigismondo
authors.initials: GS
authors.lastname: Sica
authors.forename: Marta
authors.initials: M
authors.lastname: Cossignani
authors.forename: Giovanna
authors.initials: G
authors.lastname: Condino
authors.forename: Kiron-Moy
authors.initials: KM
authors.lastname: Das
authors.forename: Francesco
authors.initials: F
authors.lastname: Pallone
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects; D053704:Capsule Endoscopy; D016022:Case-Control Studies; D003082:Colectomy / Q000009:adverse effects; D003093:Colitis, Ulcerative / Q000473:pathology* / Q000601:surgery*; D003106:Colon / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D007082:Ileum / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008679:Metaplasia; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000473:pathology; D012007:Rectum / Q000601:surgery; D055815:Young Adult
references.citation: Dig Dis Sci. 1989 Oct;34(10):1505-10
references.pmid: 2791801
references.citation: Gastroenterology. 1976 Mar;70(3):439-44
references.pmid: 1248701
references.citation: Dig Dis Sci. 1992 Dec;37(12):1882-9
references.pmid: 1335407
references.citation: Gut. 1999 Oct;45(4):542-5
references.pmid: 10486362
references.citation: Am J Gastroenterol. 2005 Jan;100(1):93-101
references.pmid: 15654787
references.citation: Lancet. 1956 Sep 15;271(6942):532-6
references.pmid: 13368449
references.citation: J Gastrointest Surg. 2003 Feb;7(2):246-53; discussion 253-4
references.pmid: 12600449
references.citation: Gastroenterology. 2002 Oct;123(4):999-1005
references.pmid: 12360460
references.citation: Am J Surg. 2005 Jul;190(1):39-42
references.pmid: 15972169
references.citation: Colorectal Dis. 2007 Jun;9(5):384-92
references.pmid: 17504334
references.citation: Br J Surg. 1998 Jun;85(6):800-3
references.pmid: 9667712
references.citation: Br J Surg. 1977 Feb;64(2):77-83
references.pmid: 890251
references.citation: J Cell Biol. 1988 Aug;107(2):563-72
references.pmid: 3047141
references.citation: Aliment Pharmacol Ther. 1997 Dec;11(6):1041-6
references.pmid: 9663827
references.citation: Proc Natl Acad Sci U S A. 2000 Aug 1;97(16):8799-806
references.pmid: 10922038
references.citation: Dis Colon Rectum. 1989 Apr;32(4):323-6
references.pmid: 2538299
references.citation: Arch Surg. 1996 May;131(5):497-500; discussion 501-2
references.pmid: 8624195
references.citation: Nature. 2000 Jun 29;405(6790):1073-7
references.pmid: 10890451
references.citation: Clin Exp Immunol. 1999 Nov;118(2):219-27
references.pmid: 10540182
references.citation: Nature. 2000 May 25;405(6785):417
references.pmid: 10839527
references.citation: Ann Surg. 2003 Sep;238(3):433-41; discussion 442-5
references.pmid: 14501509
references.citation: Am J Surg Pathol. 2005 Nov;29(11):1472-81
references.pmid: 16224214
references.citation: Gastroenterology. 2002 Feb;122(2):512-30
references.pmid: 11832465
references.citation: Scand J Surg. 2005;94(1):40-2
references.pmid: 15865115
references.citation: Inflamm Bowel Dis. 1999 Feb;5(1):33-9
references.pmid: 10028447
references.citation: Am J Gastroenterol. 2003 Dec;98(12):2719-26
references.pmid: 14687823
references.citation: J Clin Invest. 1985 Jul;76(1):311-8
references.pmid: 4019782
references.citation: Dis Colon Rectum. 1987 Jan;30(1):25-8
references.pmid: 3026757
references.citation: Inflamm Bowel Dis. 2007 Oct;13(10):1256-65
references.pmid: 17577246
references.citation: Gastroenterology. 2000 Dec;119(6):1454-60
references.pmid: 11113066
references.citation: Dig Dis. 1997 May-Jun;15(3):172-88
references.pmid: 9158926
references.citation: Dis Colon Rectum. 2005 Nov;48(11):2038-46
references.pmid: 16175321
references.citation: Surg Gynecol Obstet. 1993 Dec;177(6):565-72
references.pmid: 8266266
references.citation: Gut. 1990 Mar;31(3):247-9
references.pmid: 2182398
references.citation: Neth J Med. 1989 Jun;35 Suppl 1:S54-66
references.pmid: 2702314
references.citation: Gastroenterology. 2003 May;124(5):1202-9
references.pmid: 12730861
references.citation: J Immunol. 1993 Mar 15;150(6):2487-93
references.pmid: 8450225
references.citation: Mayo Clin Proc. 1994 May;69(5):409-15
references.pmid: 8170189
references.citation: Am J Gastroenterol. 2005 Dec;100(12):2796-807
references.pmid: 16393238
references.citation: Gastroenterology. 2004 May;126(6):1611-9
references.pmid: 15168371
references.citation: Gut. 2004 Jan;53(1):108-14
references.pmid: 14684584
references.citation: Gastroenterology. 1994 Aug;107(2):435-43
references.pmid: 8039620
references.citation: Gastroenterology. 2000 Aug;119(2):305-9
references.pmid: 10930365
references.citation: Gastroenterology. 1990 Oct;99(4):956-63
references.pmid: 2394349