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Perinuclear anti-neutrophil cytoplasmic antibody and refractory pouchitis. A case-control study
J Aisenberg1, J Wagreich, J Shim
1Department of Medicine, Mount Sinai Hospital, New York, New York, USA.
Digestive Diseases and Sciences
|September 1, 1995
Summary
Refractory pouchitis (RP) does not appear to be Crohn's disease. This study found perinuclear anti-neutrophil cytoplasmic antibody (pANCA) levels were not significantly different in RP patients compared to controls.
Area of Science:
- Gastroenterology
- Immunology
Background:
- Refractory pouchitis (RP) affects 2.5% of patients with ileal pouch reservoirs.
- The etiology of RP is unknown, with a hypothesis suggesting it reflects underlying Crohn's disease.
- Perinuclear anti-neutrophil cytoplasmic antibody (pANCA) can help differentiate ulcerative colitis from Crohn's disease.
Purpose of the Study:
- To investigate whether refractory pouchitis (RP) is indicative of "missed" Crohn's disease.
- To determine the anti-neutrophil cytoplasmic antibody (ANCA) status in patients with RP.
Main Methods:
- Assessed pANCA status in 26 patients with RP.
- Compared pANCA status with 42 matched control subjects without pouchitis.
- Evaluated preoperative and postoperative extraintestinal manifestations (EIMs) and pouch biopsy histology.
Main Results:
- pANCA was positive in 42% of RP cases and 57% of controls (not significant).
- Patients with ileal pouch-anal anastomosis (IAPT) RP showed more preoperative EIMs than controls.
- No pathognomonic histologic features of Crohn's disease were found in RP pouch biopsies.
Conclusions:
- Refractory pouchitis (RP) does not appear to reflect underlying Crohn's disease.
- RP may be associated with extraintestinal manifestations (EIMs) of inflammatory bowel disease.