Ileal lesions in patients with ulcerative colitis after ileo-rectal anastomosis: relationship with colonic metaplasia.
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.
Biancone
Livia
L
Cattedra di Gastroenterologia, Dipartimento di Medicina Interna, Universita "Tor Vergata", Via Montpellier 1, Rome 00133, Italy. biancone@med.uniroma2.it
Calabrese
Emma
E
Palmieri
Giampiero
G
Petruzziello
Carmelina
C
Onali
Sara
S
Sica
Giuseppe-Sigismondo
GS
Cossignani
Marta
M
Condino
Giovanna
G
Das
Kiron-Moy
KM
Pallone
Francesco
F
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
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