title: Meta-analysis: serological markers and the risk of acute and chronic pouchitis.
abstract: BACKGROUND
  Serological markers such as anti-neutrophil cytoplasmic antibody (ANCA) and anti-Saccharomyces cerevisiae antibody (ASCA) may be associated with pouchitis after ileal pouch-anal anastomosis (IPAA).
  
  
  OBJECTIVE
  To perform a systematic review with meta-analysis of studies evaluating the association of ANCA and ASCA status with risk of acute and chronic pouchitis after IPAA.
  
  
  METHODS
  We searched multiple databases (upto September 2012) for studies reporting ANCA and/or ASCA status along with risk of acute or chronic pouchitis after IPAA in adults with ulcerative colitis (UC). We abstracted odds ratio (OR) or raw data from the individual studies to calculate summary OR estimates with 95% CIs using random-effects model.
  
  
  RESULTS
  Eight studies reporting 184 cases of acute pouchitis and six studies reporting 151 cases of chronic pouchitis were included. The odds of chronic pouchitis were 76% higher in ANCA-positive patients than ANCA-negative (six studies; OR: 1.76; 95% CI: 1.19-2.61; P < 0.01). ASCA-positivity was not associated with the risk of chronic pouchitis (three studies; OR: 0.89; 95% CI: 0.49-1.59; P = 0.68). Neither ANCA (eight studies; OR: 1.54; 95% CI: 0.79-3.02; P = 0.21) nor ASCA-positivity (two studies; OR: 1.28; 95% CI: 0.25-6.54; P = 0.77) were associated with the risk of acute pouchitis.
  
  
  CONCLUSIONS
  The risk of chronic pouchitis after IPAA is higher in ANCA-positive patients, but the risk of acute pouchitis is unaffected by ANCA status. ASCA status was not associated with the risk of acute or chronic pouchitis. This information may be used to counsel UC patients regarding their risk of pouchitis after IPAA.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: S
authors.initials: S
authors.lastname: Singh
authors.forename: P K
authors.initials: PK
authors.lastname: Sharma
authors.forename: E V
authors.initials: EV
authors.lastname: Loftus
authors.forename: D S
authors.initials: DS
authors.lastname: Pardi
mesh_terms: D000208:Acute Disease; D001003:Anal Canal / Q000601:surgery; D000714:Anastomosis, Surgical; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood*; D000907:Antibodies, Bacterial / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D002908:Chronic Disease; D003093:Colitis, Ulcerative / Q000601:surgery; D039021:Colonic Pouches; D006801:Humans; D019449:Pouchitis / Q000097:blood* / Q000209:etiology*; D016737:Proctocolectomy, Restorative / Q000009:adverse effects*; D012307:Risk Factors; D012441:Saccharomyces cerevisiae / Q000276:immunology
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic; D000907:Antibodies, Bacterial; D015415:Biomarkers