title: Increased crypt apoptosis is a feature of autoimmune-associated chronic antibiotic refractory pouchitis.
abstract: BACKGROUND
  Restorative proctocolectomy with IPAA is the surgical treatment of choice in patients with ulcerative colitis who require colectomy. Pouchitis is the most common long-term complication in patients with IPAA. While immune-mediated disorders frequently coexist with IBD, they appear to be associated with an increased risk for chronic antibiotic-refractory pouchitis.
  
  
  OBJECTIVE
  This study aimed to evaluate histologic features of autoimmune-associated chronic antibiotic-refractory pouchitis in comparison with controls and to assess their possible diagnostic utility.
  
  
  METHODS
  Clinical definition for autoimmune-associated chronic pouchitis included 1) chronic antibiotic-refractory pouchitis with response only to corticosteroids, immunomodulators, or biologics; 2) positive serum autoantibodies, including antinuclear antibody, rheumatoid factor, and antimicrosomal antibody; and 3) concurrent immune-mediated disorders. Various histologic features of pouch biopsy specimens were evaluated.
  
  
  METHODS
  The investigation was conducted at a tertiary referral center.
  
  
  METHODS
  From our Pouchitis Registry, all eligible patients with autoimmune-associated pouchitis (n = 17) were included. The control groups included 16 patients with nonautoimmune-associated chronic antibiotic-refractory pouchitis, 39 with antibiotic-responsive pouchitis, and 19 patients with normal pouches. Various histologic features of pouch biopsy specimens were evaluated.
  
  
  RESULTS
  In comparison with the control groups, the autoimmune-associated pouchitis group showed a significant increase in deep crypt apoptosis (p < 0.001). It also showed more pyloric gland metaplasia in comparison with antibiotic-responsive pouchitis and normal pouches. With the use of apoptosis score which we developed as a diagnostic marker for autoimmune-associated chronic antibiotic-refractory pouchitis, we constructed a receiver operating curve and obtained an area-under-curve value of 0.89 (95% CI: 0.79, 0.99).
  
  
  CONCLUSIONS
  Increased deep crypt apoptosis is a distinctive histologic feature of autoimmune-associated chronic antibiotic-refractory pouchitis, and this feature may aid in the diagnosis and differential diagnosis in pouchitis.
authors.affiliation: Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Wei
authors.initials: W
authors.lastname: Jiang
authors.forename: John R
authors.initials: JR
authors.lastname: Goldblum
authors.forename: Rocio
authors.initials: R
authors.lastname: Lopez
authors.forename: Lei
authors.initials: L
authors.lastname: Lian
authors.forename: Bo
authors.initials: B
authors.lastname: Shen
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017209:Apoptosis / Q000276:immunology*; D001327:Autoimmune Diseases / Q000188:drug therapy / Q000276:immunology / Q000473:pathology*; D015551:Autoimmunity; D001706:Biopsy; D002908:Chronic Disease; D003093:Colitis, Ulcerative / Q000601:surgery; D003113:Colonoscopy; D024881:Drug Resistance, Bacterial; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D019449:Pouchitis / Q000188:drug therapy / Q000276:immunology / Q000473:pathology*; D016737:Proctocolectomy, Restorative / Q000009:adverse effects*; D011379:Prognosis; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents; D005938:Glucocorticoids; D007166:Immunosuppressive Agents