ASCA IgG and CBir antibodies are associated with the development of Crohn's disease and fistulae following ileal pouch-anal anastomosis.
BACKGROUND
For ulcerative colitis (UC) patients undergoing ileal pouch-anal anastomosis (IPAA), postoperative complications include chronic pouchitis and development of Crohn's disease (CD) of the pouch.


OBJECTIVE
The aim of this study was to determine if serologic markers obtained postoperatively are associated with the development of complications in UC patients after IPAA.


METHODS
A retrospective chart review was conducted of UC patients with IPAA were tested for expression of serologic markers. Complications abstracted from medical records included postoperative fistula, CD of the pouch, chronic pouchitis, and diversion or excision of the pouch.


RESULTS
142 patients were enrolled, 44 of whom developed complications. Positive serologic profiles for ASCA IgG and anti-CBir1 markers were found to be associated with the development of any complication, (P = 0.017 and P = 0.002, respectively). A positive anti-CBir1 test was also found to be associated with CD of the pouch and/or fistula formation (P < 0.001). Similarly, both ASCA IgG and anti-CBir1 titers were significantly associated with postoperative IPAA complications (P = 0.034 and P = 0.001, respectively), and anti-CBir1 titers were associated with CD of the pouch and/or fistula formation (P < 0.001). Complications developed after a median follow-up of 216 months (range 1-264).


CONCLUSIONS
ASCA IgG and anti-CBir1 markers were associated with the development of complications after IPAA, specifically fistulae and/or CD of the pouch. The ability to identify patients at high risk for adverse outcomes may allow for early aggressive therapy, which may decrease the rate of pouch failure. A prospective study of patients with preoperative serology is ongoing.
Department of Medicine, Section of Gastroenterology, Boston Medical Center, Boston, MA 02118, USA. Jennifer.Coukos@bmc.org
Jennifer A
JA
Coukos
Lauren A
LA
Howard
Janice M
JM
Weinberg
James M
JM
Becker
Arthur F
AF
Stucchi
Francis A
FA
Farraye
D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000032:analysis / Q000276:immunology*; D015415:Biomarkers / Q000032:analysis / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000601:surgery*; D039021:Colonic Pouches / Q000009:adverse effects*; D016001:Confidence Intervals; D003424:Crohn Disease / Q000209:etiology / Q000276:immunology* / Q000503:physiopathology; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005408:Flagellin / Q000276:immunology / Q000378:metabolism; D005500:Follow-Up Studies; D006801:Humans; D007074:Immunoglobulin G / Q000276:immunology / Q000378:metabolism; D007412:Intestinal Fistula / Q000209:etiology / Q000276:immunology*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D019449:Pouchitis / Q000175:diagnosis / Q000276:immunology* / Q000503:physiopathology; D016737:Proctocolectomy, Restorative / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D055815:Young Adult
D019268:Antibodies, Antineutrophil Cytoplasmic; D015415:Biomarkers; C502160:CBir1 flagellin; D007074:Immunoglobulin G; D005408:Flagellin