Pathy/Focal Chronic Pouchitis Is Related to Crohn's Disease
Xueli Hao, Wei Xin. University Hospitals Case Medical Center, Cleveland, OH; Case Western Reserve University, Cleveland, OH
Background: Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the surgical option for ulcerative colitis (UC) refractory to medical treatment. One of the most common complications of IPAA is chronic pouchitis. Most pouchitis can be resolved by medical treatment. Some patients may develop chronic antibiotic-refractory pouchitis and Crohn's disease after close follow-up. Here, we carried out studies to evaluate morphologic features of pouchitis that can be used to predict the late development of Crohn's disease.
Design: 33 cases of pouch biopsies from 33 patients that have refractory chronic pouchitis were collected and reviewed. We divided them into two groups: 9 patients have confirmed Crohn's disease by histologically and clinically fistula formation of the pouch and 24 patients have non-Crohn's pouchitis. The following histologic features were compared between these two groups of patients: distribution of inflammation, granulomas, pyloric metaplasia, lymphoid aggregates, cryptitis/ulcer, crypt distortion, and tissue eosinophilia. Data were analyzed by Fisher's exact test.
Results: Of patients with Crohn's disease of the pouch, 8 of 9 (88.8%) have patchy/focal chronic inflammation compared to 9 of 24 patients (37.5%) who have non-Crohn's pouchitis (p=0.016).
The sensitivity and specificity of patchy inflammation in detecting Crohn's disease of the pouch is 88.8% and 62.5% respectively. Granulomas were only found in Crohn's disease of the pouch, but not in other conditions (1/9). There was no statistical significance between two groups as to pyloric gland metaplasia, lymphoid aggregates, cryptitis/ulcer, crypt distortion and tissue eosinophilia.
Conclusions: Patchy/focal chronic pouchitis is an predictor of late development of Crohn's disease of the pouch. Documentation of patchy/focal pouchitis in the biopsy is important and should raise the differential diagnosis of Crohn's disease.
Wednesday, March 6, 2013 1:00 PM
Poster Session VI # 104, Wednesday Afternoon