title: Primary sclerosing cholangitis is associated with endoscopic and histologic inflammation of the distal afferent limb in patients with ileal pouch-anal anastomosis.
abstract: BACKGROUND
  We hypothesized that patients with primary sclerosing cholangitis (PSC) may have a higher risk for prepouch ileitis in the setting of ileal pouch-anal anastomosis (IPAA). The aim of this study was to compare endoscopic and histologic inflammation in the afferent limb (prepouch ileum) and pouch between IPAA patients with and without PSC.
  
  
  METHODS
  In all, 39 consecutive inflammatory bowel disease (IBD) and IPAA patients with PSC (study group) were identified and 91 IBD and IPAA patients without PSC (control group) were randomly selected with a 1:2 ratio. Demographic, clinical, endoscopic, and histologic variables were analyzed.
  
  
  RESULTS
  There were no significant differences in age, gender, and nonsteroidal antiinflammatory drug use between the study and control groups. Twelve (30.8%) patients in the IPAA-PSC group had coexisting autoimmune disorders, in contrast to five (5.5%) patients in the IPAA control group (P < 0.001). More patients in the study group had endoscopic inflammation as demonstrated by the higher Pouchitis Disease Activity Index (PDAI) endoscopic scores of the afferent limb and pouch body than those in the control group (P = 0.02 and P < 0.001, respectively). In addition, more patients with PSC had higher PDAI histologic scores of the afferent limb than those without PSC (P < 0.001). Multivariate analysis showed higher PDAI endoscopy and histology subscores were associated with risk for PSC, with odds ratio 1.34 (95% confidence interval [CI]: 1.34, 3.79) and 1.61 (95% CI: 1.00, 2.58), respectively.
  
  
  CONCLUSIONS
  Concurrent PSC appears to be associated with a significant prepouch ileitis on endoscopy and histology in patients with IPAA. Pouch patients with long segment of ileitis should be evaluated for PSC.
authors.affiliation: Department of Gastroenterology, the Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. shenb@ccf.org
authors.forename: Bo
authors.initials: B
authors.lastname: Shen
authors.forename: Ana E
authors.initials: AE
authors.lastname: Bennett
authors.forename: Udayakumar
authors.initials: U
authors.lastname: Navaneethan
authors.forename: Lei
authors.initials: L
authors.lastname: Lian
authors.forename: Zhuo
authors.initials: Z
authors.lastname: Shao
authors.forename: Ravi P
authors.initials: RP
authors.lastname: Kiran
authors.forename: Victor W
authors.initials: VW
authors.lastname: Fazio
authors.forename: Feza H
authors.initials: FH
authors.lastname: Remzi
mesh_terms: D000328:Adult; D000343:Afferent Loop Syndrome / Q000150:complications*; D001003:Anal Canal / Q000473:pathology; D000714:Anastomosis, Surgical / Q000009:adverse effects*; D016022:Case-Control Studies; D015209:Cholangitis, Sclerosing / Q000175:diagnosis / Q000209:etiology*; D015331:Cohort Studies; D003093:Colitis, Ulcerative / Q000150:complications*; D039021:Colonic Pouches; D004724:Endoscopy; D005260:Female; D006801:Humans; D007079:Ileitis / Q000150:complications*; D007249:Inflammation / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D016737:Proctocolectomy, Restorative; D011379:Prognosis; D011446:Prospective Studies