Original article—alimentary tract
Antimicrobial Antibodies Are Associated With a Crohn's Disease–Like Phenotype After Ileal Pouch–Anal Anastomosis

https://doi.org/10.1016/j.cgh.2011.09.016Get rights and content

Background & Aims

Pouchitis and Crohn's disease (CD)-like (CDL) complications of the pouch occur at rates near 50% and 20%, respectively, after colectomy with ileal pouch–anal anastomosis (IPAA) for ulcerative colitis (UC). We investigated whether antimicrobial antibodies are associated with pouch outcome after IPAA.

Methods

We studied clinical and endoscopic data from 399 individuals with UC who underwent colectomy with IPAA at Mount Sinai Hospital in Toronto, Canada; patients were classified as no pouchitis (NP), chronic pouchitis (CP), or CDL. Serum samples were analyzed from 341 patients for antibodies against Saccharomyces cerevisiae (ASCA), OmpC, CBir1, and perinuclear antineutrophil cytoplasmic antibody (pANCA).

Results

Of the subjects, 70.7% had NP, 16.8% developed CP, and 12.5% developed CDL. Smoking was associated with CDL (P = .003). Ashkenazi Jewish individuals more commonly had CP (P = .008). Of patients with CDL, 53.5% and 14.0% had positive test results for anti-CBir1 and ASCA (immunoglobulin G), respectively, compared with 21.4% and 3.8% of those with NP and 28.3% and 5.0% of those with CP (P < .0001 and P = .03). Anti-CBir1 was associated with CDL, compared with NP (P = 2.8 × 10–5; odds ratio [OR], 4.2; 95% confidence interval [CI], 2.2–8.3) or CP (P = .011; OR, 2.9; 95% CI, 1.3–6.6). ASCA immunoglobulin G was associated with CDL, compared with patients with NP (P = .01; OR, 4.1; 95% CI, 1.4–12.3). In a combined model, pANCA and the antimicrobial antibodies were associated with CP (P = .029) and CDL (P = 4.7 × 10–4).

Conclusions

Antimicrobial antibodies and pANCA are associated with inflammatory complications of the pouch. The CDL phenotype is associated with factors that characterize Crohn's disease, including smoking, anti-CBir1, and ASCA.

Section snippets

Study Population

More than 1600 patients who had undergone IPAA before 2007 at Mount Sinai Hospital in Toronto, Canada, and who were registered in a Pelvic Pouch database were contacted to participate in the study, which was approved by the Research Ethics Board of Mount Sinai Hospital. All patients provided written informed consent.

Patients with a confirmed precolectomy diagnosis of UC who had a minimum of 2-year follow-up after ileostomy closure were eligible for the study. Patients with confirmed or

Results

One thousand four hundred twenty-seven patients from the Mount Sinai Hospital Pelvic Pouch Database were contacted, and 420 patients with a precolectomy diagnosis of UC were included and provided consent to participate in the study. Twenty-one patients were excluded after medical records review: 10 patients with familial adenomatous polyposis, 10 with a precolectomy diagnosis of indeterminate colitis or IBDU, and 1 because of a precolectomy diagnosis of microscopic colitis. The remaining 399

Discussion

The development of CP and a CDL phenotype of the pouch after IPAA for UC are among the greatest risk factors for pouch failure after surgery.7 A model to help identify UC patients at risk for complications after IPAA would be very useful when counseling patients in whom colectomy is a consideration for management. A number of studies have examined clinical risk factors as predictors of outcome demonstrating that smoking, family history of CD, and Ashkenazi Jewish ethnicity are associated with a

Acknowledgments

The authors would like to thank Diane Verbeeten and Lucy T. Zhang for their assistance with the study, and Harden Huang and Brenda O'Connor for maintaining and providing access to the Mount Sinai Hospital Pelvic Pouch Database.

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    Conflicts of interest This author discloses the following: Dr Silverberg receives research support and consulting fees from Prometheus Laboratories. The remaining authors disclose no conflicts.

    Funding Supported by Crohn's and Colitis Foundation of Canada, Zane Cohen Centre for Digestive Diseases.

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