Laboratory tests for patients with ileal pouch-anal anastomosis: clinical utility in predicting, diagnosing, and monitoring pouch disorders.
Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the surgical treatment of choice for patients with medically refractory ulcerative colitis (UC) or UC-associated dysplasia, and for the majority of patients with familial adenomatous polyposis. Pouchitis and other complications of IPAA are common. There are scant data on laboratory markers for the evaluation and diagnosis of pouch disorders. The presence of immunogenotypic markers such as genetic polymorphisms of interleukin-1 (IL-1) receptor antagonist, NOD2/CARD15, Toll-like receptor, and tumor necrosis factor-alpha has been reported to be associated with pouchitis. Immunophenotypic/serologic markers such as perinuclear antineutrophil cytoplasmic antibody and anti-CBir1 have been investigated as possible markers for predicting and diagnosing pouchitis. Fecal markers including lactoferrin and calprotectin seem to be useful in distinguishing inflammatory from noninflammatory pouch disorders. In our practice, we have encountered a large number of pouch patients with Clostridium difficile infection. Laboratory evaluation provides information on the etiology and pathogenesis of pouchitis, and it also helps practicing clinicians with accurate diagnosis, differential diagnosis, disease stratification, and management of ileal pouch disorders.
Navaneethan
Udayakumar
U
The Pouchitis Clinic, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Shen
Bo
B
D015415:Biomarkers / Q000032:analysis; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000175:diagnosis* / Q000382:microbiology; D003093:Colitis, Ulcerative / Q000601:surgery*; D039021:Colonic Pouches; D003937:Diagnosis, Differential; D005819:Genetic Markers; D006801:Humans; D011183:Postoperative Complications / Q000175:diagnosis* / Q000382:microbiology; D019449:Pouchitis / Q000175:diagnosis* / Q000382:microbiology; D016737:Proctocolectomy, Restorative; D012307:Risk Factors
D015415:Biomarkers; D005819:Genetic Markers