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Increased cytokine transcripts in pouchitis reflect the degree of inflammation but not the underlying entity

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background and aims

After ileopouch anal anastomosis (IPAA), 10–40% of patients with ulcerative colitis (UC) but only 5% of patients with familial adenomatous polyposis (FAP) develop pouchitis. Immunoregulatory abnormalities might be of importance in the pathogenesis of the disease. Therefore, we characterized cytokine and chemokine transcripts in inflamed and non-inflamed pouches in patients with UC compared to those with FAP and Crohn's disease (CD).

Patients and methods

Mucosal biopsies were taken from 87 patients with IPAA [UC (n=70), CD (n=8) or FAP (n=9)]. Patients with active ileal CD (n=14), active UC (n=17) and non-inflammatory conditions (n=12) served as controls. The expression of 20 gene transcripts was quantified using real-time polymerase chain reaction.

Results and findings

Pro-inflammatory cytokines and chemokines are significantly increased in IPAA patients with acute pouchitis. This increase is independent of the underlying disease (UC or CD) and reflects the degree of inflammation. A good correlation between pouchitis activity (using the Pouchitis Disease Activity Index) and the MRP-14, interleukin-8, macrophage inflammatory protein-2α and matrix metalloproteinase-1 transcripts was observed.

Interpretations and conclusions

Our data support the view that pouchitis reflects an inflammatory process that is different from that of underlying inflammatory bowel diseases, as the cytokine and chemokine patterns in pouchitis are neither typical of CD nor of UC, but maybe due to bacterial intestinal microflora overgrowth in the pouch lumen. Quantification of transcript levels allows an estimation of the extent of mucosal inflammation and may become helpful in the evaluation of the disease, especially in clinical trials.

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Acknowledgements

This work was supported by grants from the Bundesministerium für Bildung und Forschung (“Network of competence: chronic inflammatory bowel disease”; “molecular markers” and “pouchitis” working groups). The authors thank the nursing staff of the Endoscopy Department.

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Authors and Affiliations

  1. Department of Internal Medicine II, Saarland University Hospital, Homburg/Saar, Germany

    C. Schmidt, B. Ludwig, M. Menges & S. Zeuzem

  2. Department of Immunology, Ruprecht Karl University, Heidelberg, Germany

    T. Giese & S. C. Meuer

  3. Department of Surgery, Saarland University Hospital, Homburg/Saar, Germany

    M. Schilling

  4. Department of Gastroenterology, Marienhospital Altenessen, Essen, Germany

    A. Stallmach

  5. Klinik für Gastroenterologie, Hepatologie und Ernährungsmedizin, Katholische Kliniken Essen-Nord, Marienhospital Altenessen, Hospitalstraße 24, 45329, Essen, Germany

    A. Stallmach

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  1. C. Schmidt
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  2. T. Giese
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  3. B. Ludwig
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  8. A. Stallmach
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Correspondence to A. Stallmach.

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Schmidt, C., Giese, T., Ludwig, B. et al. Increased cytokine transcripts in pouchitis reflect the degree of inflammation but not the underlying entity. Int J Colorectal Dis 21, 419–426 (2006). https://doi.org/10.1007/s00384-005-0024-2

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  • DOI: https://doi.org/10.1007/s00384-005-0024-2

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