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  • High level perinuclear antineutrophil cytoplasmic antibody (pANCA) in ulcerative colitis patients before colectomy predicts the development of chronic pouchitis after ileal pouch-anal anastomosis

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Inflammation and inflammatory bowel disease
High level perinuclear antineutrophil cytoplasmic antibody (pANCA) in ulcerative colitis patients before colectomy predicts the development of chronic pouchitis after ileal pouch-anal anastomosis
  1. P R Fleshnera,
  2. E A Vasiliauskasb,
  3. L Y Kamb,
  4. N E Fleshnerc,
  5. J Gaiennieb,
  6. M T Abreu-Martinb,
  7. S R Targanb
  1. aDivision of Colon and Rectal Surgery, Department of Surgery, Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA, bDivision of Gastroenterology, Department of Medicine, Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA, cDepartment of Surgery, Toronto Sunnybrook Regional Cancer Centre, Toronto, Ontario M4N 3M5, Canada
  1. Dr P Fleshner, 8737 Beverly Boulevard, Suite 403, Los Angeles, CA 90048, USA. PFleshner{at}aol.com

Abstract

BACKGROUND The reported cumulative risk of developing pouchitis in ulcerative colitis (UC) patients undergoing ileal pouch-anal anastomosis (IPAA) approaches 50% after 10 years. To date, no preoperative serological predictor of pouchitis has been found.

AIMS To assess whether preoperative perinuclear antineutrophil cytoplasmic antibody (pANCA) expression was associated with acute and/or chronic pouchitis after IPAA.

METHODS Patients were prospectively assessed for the development of clinically and endoscopically proved pouchitis. Serum obtained at the time of colectomy in 95 UC patients undergoing IPAA was analysed for pANCA by ELISA and indirect immunofluorescence. pANCA+ 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.

RESULTS Sixty of the 95 patients (63%) expressed pANCA. After a median follow up of 32 months (range 1–89), 32 patients (34%) developed either acute (n=14) or chronic (n=18) pouchitis. Pouchitis was seen in 42% of pANCA+ patients compared with 20% of pANCA− patients (p=0.09). There was no significant difference in the incidence of acute pouchitis between the three pANCA+ 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− (20%) (p=0.005). 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 (p=0.005).

CONCLUSION High level pANCA before colectomy is significantly associated with the development of chronic pouchitis after IPAA.

  • pouchitis
  • perinuclear antineutrophil cytoplasmic antibody
  • inflammatory bowel disease
  • ulcerative colitis
  • ileal pouch-anal anastomosis

  • Abbreviations used in this paper

    UC
    ulcerative colitis
    PSC
    primary sclerosing cholangitis
    pANCA
    perinuclear antineutrophil cytoplasmic antibody
    IPAA
    ileal pouch-anal anastomosis
    EIM
    extraintestinal manifestations
    EU
    ELISA unit

    • https://doi.org/10.1136/gut.49.5.671

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    • Abbreviations used in this paper

      UC
      ulcerative colitis
      PSC
      primary sclerosing cholangitis
      pANCA
      perinuclear antineutrophil cytoplasmic antibody
      IPAA
      ileal pouch-anal anastomosis
      EIM
      extraintestinal manifestations
      EU
      ELISA unit
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