FECAL ALPHA(1)-ANTITRYPSIN CONCENTRATION IN THE DIAGNOSIS AND MANAGEMENT OF PATIENTS WITH POUCHITIS

Objective: To investigate the role of faecal alpha(1)-antitrypsin conc entration in the diagnosis and management of patients with ileal pouch -anal anastomosis. Design: Prospective study. Methods: Fifty-two measu rements of faecal alpha(1)-antitrypsin concentration were taken from 3 3 patients operated on for ulcerative colitis. Results: Patients with active pouchitis (44.4 +/- 7.1 mg%) had a three-fold higher mean faeca l alpha(1)-antitrypsin concentration than patients in remission (13.7 +/- 1.3 mg%; P<0.0001), than patients who had never had pouchitis (14. 4 +/- 2.3 mg%; P<0.003) and than patients with incontinent ileostomies (12.7 +/- 1.3 mg%; P < 0.004). Faecal alpha(1)-antitrypsin measuremen ts were 80% sensitive and 97% specific for active pouchitis. A signifi cant positive correlation between the pouchitis disease activity index and faecal protein loss was observed (r = 0.702; P < 0.0001). The cor relations between protein loss and other parameters were weaker (prote in loss versus clinical score, r = 0.309; versus endoscopic score, r = 0.583; and versus histologic score, r = 0.558). Conclusion: Faecal al pha(1)-antitrypsin concentration is a good indicator of the degree of intestinal inflammation in pouchitis and may be useful as a quantitati ve index of disease activity in prospective studies.