The team assessed whether preoperative perinuclear antineutrophil cytoplasmic antibody (pANCA) expression was associated with acute and/or chronic pouchitis after ileal pouch-anal anastomosis (IPAA).
They reported their findings in the November issue of Gut.
To date, no preoperative serological predictor of pouchitis has been found.
Patients were prospectively assessed for the development of clinically and endoscopically proved pouchitis.
ELISA and indirect immunofluorescence were used to analyze pANCA in serum, obtained at the time of colectomy in 95 ulcerative colitis patients undergoing IPAA.
pANCA-positive patients were stratified into high level (>100 ELISA units [EU]/ml), n = 9), moderate level (40-100 EU/ml, n = 32), and low level (<40 EU/ml, n = 19) subgroups.
|Risk of chronic pouchitis:|
High pANCA: 56%
Medium pANCA: 22%
Low pANCA: 16%
No pANCA: 20%
A total of 60 of the 95 patients (63%) were found to express pANCA.
After a median follow-up of 32 months, 32 patients (34%) developed either acute (n = 14) or chronic (n = 18) pouchitis.
Pouchitis was seen in 42% of pANCA-positive patients, compared with 20% of pANCA-negative patients.
There was no significant difference in the incidence of acute pouchitis between the three pANCA-positive patient subgroups.
The cumulative risk of developing chronic pouchitis among patients with high level pANCA (56%) before colectomy was significantly higher than in patients with medium level (22%), low level (16%), and those who were pANCA-negative (20%).
Multivariate analysis revealed that the sole parameter significantly associated with the development of chronic pouchitis after IPAA was the presence of high level pANCA before colectomy.