Inflammation of
ileal reservoir mucosa ("
pouchitis") is a common sequelae in
ulcerative colitis (UC) patients who have had a
colectomy with
ileal pouch anal-anastomosis (IPAA). Although several clinical, genetic, and laboratory parameters have been evaluated, reliable pathologic predictors for the development of
pouchitis are lacking. The purpose of this case-control study was to determine whether there are any pathologic features in UC
colectomy specimens that may help predict the subsequent development of
pouchitis after an IPAA procedure. The study group consisted of 39 UC patients (male/female ratio: 21/18, mean age: 35 years), who had at least 1 episode of
pouchitis after an IPAA procedure during the follow-up period (mean: 57 months, range: 12-121 months). There were 26 control patients (male/female ratio: 11/15, mean age: 37 years), all of whom also underwent a total
colectomy and IPAA procedure for UC, but did not develop
pouchitis during the follow-up period (mean: 78 months, range: 14-223 months). Routinely processed tissues from each
colectomy specimen were evaluated for a variety of histologic features, such as extent of
colitis, severity of
colitis, extent of severe
colitis, type and extent of ulceration, presence and severity of appendiceal
inflammation, and the presence of active
ileitis, and compared between the study and control patients. Pathologic features that were associated with the subsequent development of
pouchitis included the presence of severe
colitis that extended into the cecum (severe pancolitis), which was present in 7/39 (18%)
pouchitis patients, but in none (0%) of the control patients (P = 0.03), early fissuring
ulcers [9/39 (23%)
pouchitis cases versus 1/26 (4%) controls (P = 0.04)], active
inflammation of the appendix [20/32 (63%)
pouchitis patients versus 7/19 (31%) controls (P = 0.03)], and appendiceal ulceration [13/32 (41%)
pouchitis patients versus none (0%) of the controls (P = 0.002)]. No significant differences in patient gender or age, depth or extent of ulceration, or the presence or absence of "backwash
ileitis" were identified between the 2 groups. In conclusion, there are several histologic features in
colectomy specimens from UC patients who have undergone an IPAA procedure that may help predict the subsequent development of
pouchitis. Of these features, appendiceal ulceration is highly associated with
pouchitis.