Clinical implication of false-positive celiac serology in patients with ileal pouch.
BACKGROUND
In patients with symptoms of pouchitis retractable to antibiotic therapy, serology is often ordered to exclude concurrent celiac disease. The clinical utility of celiac serology in patients with ileal pouches is unknown. The aim of this study was to investigate the clinical implications of false-positive celiac serology in patients with ileal pouches.


METHODS
All patients with pouches who had underlying ulcerative colitis and available celiac serology were included from the subspecialty Pouchitis Clinic at the Cleveland Clinic between 2002 and 2007. Chronic antibiotic-refractory pouchitis was diagnosed based on persistent symptomatic pouchitis after a 4-week single- or dual-antibiotic therapy.


RESULTS
A total of 126 patients were studied, and a false-positive celiac serology was observed in 19 patients. Chronic antibiotic-refractory pouchitis was diagnosed in 47% (9/19) of patients with false-positive celiac serology compared with 14% (15/107) of patients with a negative celiac serology (P = .003). In multivariate analysis, the association between false-positive celiac serology and chronic antibiotic-refractory pouchitis remained significant (odds ratio, 5.4; 95% confidence interval, 1.7-16.7; P = .004) after adjusting for sex (P = .03), pouch duration (P = .83), the presence of autoimmune disorders (P = .46), and extraintestinal manifestations (P = .63).


CONCLUSIONS
False-positive celiac serology appeared to be common in patients with ileal pouch-anal anastomosis and it may be associated with chronic antibiotic-refractory pouchitis.
Lian
Lei
L
Departments of Colorectal Surgery and Gastroenterology, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
Remzi
Feza H
FH
Kiran
Ravi P
RP
Fazio
Victor W
VW
Shen
Bo
B
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002446:Celiac Disease / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D015331:Cohort Studies; D003093:Colitis, Ulcerative / Q000097:blood / Q000209:etiology / Q000601:surgery*; D039021:Colonic Pouches; D004352:Drug Resistance, Microbial; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019449:Pouchitis / Q000097:blood* / Q000175:diagnosis* / Q000209:etiology; D011237:Predictive Value of Tests; D016737:Proctocolectomy, Restorative; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
D000900:Anti-Bacterial Agents