title: Is pyloric gland metaplasia in ileal pouch biopsies a marker for Crohn's disease?
abstract: BACKGROUND
  Approximately 5-10 % of ulcerative colitis (UC) patients who undergo ileal pouch-anal anastomosis (IPAA) will develop postoperative complications such as refractory pouchitis or a change in diagnosis to Crohn's disease (CD). Serological markers and histologic aspects of the pouch such as pyloric gland metaplasia (PGM) have been associated with a risk for these complications.
  
  
  METHODS
  Twenty-eight IPAA patients with either CD of the pouch or chronic pouchitis (cases) and 36 IPAA controls who experienced a normal postoperative course were originally consented. Of these 64 subjects, 22 cases and 17 controls had histopathologic and serologic data available and were subsequently enrolled. Demographic and clinical data were entered into a database, blood analyzed for serological markers (Prometheus Labs, San Diego, CA) and biopsies of the pouch and the afferent limb reviewed by two GI pathologists.
  
  
  RESULTS
  Of the cases, 55 % (12/22) had evidence of PGM in their pouch and/or small bowel biopsies, as compared to 12 % (2/17) of the controls (p = 0.006). Of 13 subjects with CD, 77 % (10/13) were found to have PGM versus subjects with chronic pouchitis in which 22 % (2/9) were found to have PGM (p = 0.03). There was a trend of ASCA positivity (both IgG and IgA, p = 0.20) and of higher ASCA titer levels (p = 0.07) with postoperative complications.
  
  
  CONCLUSIONS
  This study suggests that the presence of ileal pouch PGM is associated with postoperative complications and favors a diagnosis of CD over UC with chronic pouchitis.
authors.affiliation: Section of Gastroenterology, Boston University School of Medicine, 85 East Concord St. 7th Floor, Boston, MA, 02118, USA, shuchi.agarwal1@gmail.com.
authors.forename: Shuchi
authors.initials: S
authors.lastname: Agarwal
authors.forename: Arthur F
authors.initials: AF
authors.lastname: Stucchi
authors.forename: Kleanthis
authors.initials: K
authors.lastname: Dendrinos
authors.forename: Sandra
authors.initials: S
authors.lastname: Cerda
authors.forename: Michael J
authors.initials: MJ
authors.lastname: O'Brien
authors.forename: James M
authors.initials: JM
authors.lastname: Becker
authors.forename: Timothy
authors.initials: T
authors.lastname: Heeren
authors.forename: Francis A
authors.initials: FA
authors.lastname: Farraye
mesh_terms: D000328:Adult; D015415:Biomarkers; D001706:Biopsy; D016022:Case-Control Studies; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000473:pathology; D039021:Colonic Pouches / Q000473:pathology*; D003424:Crohn Disease / Q000175:diagnosis* / Q000473:pathology*; D003937:Diagnosis, Differential; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology*; D006801:Humans; D008297:Male; D008679:Metaplasia; D008875:Middle Aged; D019449:Pouchitis / Q000175:diagnosis / Q000473:pathology
chemical_list: D015415:Biomarkers
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