title: Development of pouchitis following ileal pouch-anal anastomosis (IPAA) for ulcerative colitis: A role for serological markers and microbial pattern recognition receptor genes.
abstract: OBJECTIVE
  Pouchitis, the most common complication after proctocolectomy with ileal pouch-anal anastomosis (IPAA) for ulcerative colitis, has been attributed to altered composition of faecal flora. We investigated the role of antimicrobial and antiglycan antibodies and polymorphisms in microbial pattern recognition receptor genes.
  
  
  METHODS
  Clinical charts of all 184 patients with ulcerative colitis who underwent IPAA between 1990-2004 were reviewed for pre- and post-operative disease course.
  
  
  RESULTS
  Follow-up data were available in 172 patients [67 female, median age at proctocolectomy 39.1 years]. During a median follow-up of 6.7 (interquartile range 3.7-10.5) years, 80 patients (47%) developed at least one episode of pouchitis. Cox proportional-hazard regression identified extra-intestinal manifestations [HR 1.78 (95%CI 1.10-2.88), p=0.020], a GT/TT genotype at Toll-like-receptor-1 S87I [HR 1.64 (1.01-2.66), p=0.047], anti-chitobioside carbohydrate antibodies [HR 2.03 (1.11-3.70), p=0.021] and young age at diagnosis [p=0.003] to be independently associated with pouchitis. Factors associated with chronic pouchitis, diagnosed in 33 patients (19%), were extra-intestinal manifestations [HR 2.45 (1.07-5.62), p=0.034], backwash ileitis [HR 3.15 (1.10-9.00), p=0.032], outer-membrane porin antibodies [HR 2.67 (1.20-5.94), p=0.016] and young age at proctocolectomy [p=0.008].
  
  
  CONCLUSIONS
  : The reported association with antibodies and Toll-like-receptor-1 supports the pathophysiological role of the faecal flora in the development of pouchitis.
authors.affiliation: Department of Gastroenterology, University Hospital Gasthuisberg, Herestraat 49, B3000 Leuven, Belgium.
authors.forename: Marc
authors.initials: M
authors.lastname: Ferrante
authors.forename: Sarah
authors.initials: S
authors.lastname: Declerck
authors.forename: Tamara
authors.initials: T
authors.lastname: Coopmans
authors.forename: Gert
authors.initials: G
authors.lastname: De Hertogh
authors.forename: Gert
authors.initials: G
authors.lastname: Van Assche
authors.forename: Freddy
authors.initials: F
authors.lastname: Penninckx
authors.forename: Paul
authors.initials: P
authors.lastname: Rutgeerts
authors.forename: Karel
authors.initials: K
authors.lastname: Geboes
authors.forename: Andre
authors.initials: A
authors.lastname: D'Hoore
authors.forename: Séverine
authors.initials: S
authors.lastname: Vermeire