Original Paper

Pouchitis in Ulcerative Colitis: Correlation between Predictors from Colectomy Specimens and Clinico-Histological Features
F. Fogt^a, J.J. Deren^b, M. Nusbaum^c, A. Wellmann^d, H.M. Ross^c

Departments of
^aPathology,
^bGastroenterology, and
^cSurgery, Presbyterian Medical Center, University of Pennsylvania, Philadelphia, Pa., USA;
^dDepartment of Pathology, University of Aachen, Aachen, Germany

Address of Corresponding Author

Eur Surg Res 2006;38:407-413 (DOI: 10.1159/000094669)

  Key Words

• Ulcerative colitis
• Pouchitis
• Surveillance biopsies

  Abstract

Pouchitis after restorative proctocolectomy for ulcerative colitis is usually of ill-defined etiology and is encountered with sclerosing cholangitis, bacterial overgrowth, and ischemia. Recently, appendiceal involvement, ileitis, and fissures in the colectomy specimen have been associated with short- and long-term development of pouchitis. To corroborate these recent findings, the histology of 40 colectomies (70% males; mean age 46.3 years, age range 20-70 years; mean follow-up period 3.7 years, range 1-13 years) with yearly follow-up biopsies was correlated with pouchitis and clinical symptoms. Appendicitis, fissures, and ileitis were present in 47, 45 and 5% of the patients, respectively. Pouchitis in patients with appendicitis or with fissures was noted in 44 and 50% at first biopsy and in 70 and 58% during follow-up (p = NS). Of the patients without appendicitis or without fissures, 33 and 33% demonstrated pouchitis at the first biopsy and 30 and 55% during follow-up (p = NS). Clinico-histological correlation revealed normal/near-normal biopsies with the lowest clinical severity score in 77% and with the highest clinical score in 43% (p < 0.025). The histological findings of appendiceal involvement, fissuring ulcers, and ileitis in colectomies for ulcerative colitis do not correlate with the finding of pouchitis in early or late pouch biopsies. A high clinical suspicion score is frequently not correlated with significant inflammation of the pouch.

Copyright © 2006 S. Karger AG, Basel

  Author Contacts

Franz Fogt, MD
Department of Pathology, Presbyterian Medical Center
University of Pennsylvania, 39th and Market Streets
Philadelphia, PA 19104 (USA)
Tel. +1 215 662 8077, Fax +1 215 662 1694, E-Mail franz.fogt@uphs.upenn.edu

  Article Information

Received: April 19, 2006
Accepted after revision: June 2, 2006
Published online: July 19, 2006
Number of Print Pages : 7
Number of Figures : 2, Number of Tables : 5, Number of References : 23