title: Evaluation of upper and lower gastrointestinal histology in patients with ileal pouches.
abstract: BACKGROUND
  Inflammatory complications of ileal pouch-anal anastomosis (IPAA), including pouchitis and Crohn's disease (CD) of the pouch, are common in patients with restorative proctocolectomy for ulcerative colitis. It is not clear whether these inflammatory conditions can affect upper GI tract. The aim of the study was to evaluate correlation between duodenal and pouch histology in patients with healthy and diseased pouches.
  
  
  METHODS
  All IPAA patients who had esophagogastroduodenoscopy with biopsy after colectomy (N = 96) were included. H&E slides of gastric, duodenal, neo-terminal ileum, and pouch body biopsies were blindly re-reviewed by an expert GI pathologist for acute and chronic inflammation. Demographic and clinical variables and pouch outcome were analyzed.
  
  
  RESULTS
  There was a significant correlation between acute inflammation in the duodenum as measured by neutrophil infiltration score and the presence of chronic pouchitis (kappa coefficient = 0.21, P < 0.05). Intraepithelial lymphocytosis of the duodenum, though uncommon, only occurred in patients with irritable pouch syndrome, chronic pouchitis, or CD of the pouch. Crypt distortion of duodenal epithelium was only seen in patients with inflammatory or structural diseases of the pouch, including acute (18.2%) and chronic (5%) pouchitis, CD of the pouch (14.3%), and surgical complications of the pouch (14.4%).
  
  
  CONCLUSIONS
  Histologic evaluation of duodenal biopsy may provide additional information in patients with ileal pouches, as patients with normal histology of the pouch may have an abnormal duodenal histology.
authors: Victor W. Fazio, MD Center for Inflammatory Bowel Disease, Digestive Disease Institute, Cleveland, OH 44195, USA.
authors: Yinghong
authors: Y
authors: Wang
authors: Ana E
authors: AE
authors: Bennett
authors: Hui
authors: H
authors: Cai
authors: Lei
authors: L
authors: Lian
authors: Bo
authors: B
authors: Shen
mesh_terms: D000714:Anastomosis, Surgical / Q000009:adverse effects; D001706:Biopsy; D003093:Colitis, Ulcerative / Q000601:surgery*; D003106:Colon / Q000473:pathology* / Q000601:surgery; D039021:Colonic Pouches / Q000473:pathology*; D004386:Duodenum / Q000473:pathology* / Q000601:surgery; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007082:Ileum / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019449:Pouchitis / Q000209:etiology / Q000473:pathology*; D016737:Proctocolectomy, Restorative / Q000009:adverse effects*; D011446:Prospective Studies