INCREASED MUCOSAL LEVELS OF LEUKOTRIENE B-4 IN POUCHITIS - EVIDENCE FOR A PERSISTENT INFLAMMATORY STATE

Design and Methods: In order to evaluate its possible role in the path ogenesis of pouchitis we measured the release, into the incubation med ium, of leukotriene B-4 from mucosal samples from patients with ileal pouch-anal anastomosis and correlated release with clinical, endoscopi c and histological features. Results: Leukotriene B-4 release was sign ificantly elevated in patients with active pouchitis in comparison to those with a normal pouch mucosa (P<0.007). No overlap was observed be tween leukotriene B-4 levels from patients with active pouchitis sampl es and those obtained from individuals without pouchitis. Effective tr eatment of pouchitis was associated with a significant reduction in le ukotriene B-4 mucosal release to the incubation medium (P<0.03). Howev er, even in remission, levels of leukotriene B-4 release remained sign ificantly increased in these patients in comparison to people who neve r experienced pouchitis (P<0.003). A modest correlation was observed b etween pouchitis disease activity index and leukotriene B-4 release (r =0.596; P<0.01). Conclusion: These results suggest that the increased production of leukotriene B-4 may be implicated in the pathogenesis of pouchitis. The persistence of an increased mucosal release of leukotr iene B-4 in pouchitis patients during clinical remission suggests the presence of a chronic, ongoing, underlying inflammatory process.