CHRONIC INFLAMMATORY CHANGES IN THE POUCH MUCOSA ARE ASSOCIATED WITH CHOLANGITIS FOUND ON PEROPERATIVE LIVER-BIOPSY SPECIMENS AT RESTORATIVE PROCTOCOLECTOMY FOR ULCERATIVE-COLITIS
P. Aitola et al., CHRONIC INFLAMMATORY CHANGES IN THE POUCH MUCOSA ARE ASSOCIATED WITH CHOLANGITIS FOUND ON PEROPERATIVE LIVER-BIOPSY SPECIMENS AT RESTORATIVE PROCTOCOLECTOMY FOR ULCERATIVE-COLITIS, Scandinavian journal of gastroenterology, 33(3), 1998, pp. 289-293
Background: The clinical syndrome of primary sclerosing cholangitis (P
SC), diagnosed in about 5% of patients with ulcerative colitis (UC), h
as been shown to be associated with pouchitis after ileal pouch-anal a
nastomosis. The aim of this study was to ascertain whether UC patients
with cholangitis on liver biopsy at proctocolectomy, with or without
the clinical syndrome of PSC, have an increased risk of inflammatory c
hanges in the ileal reservoir mucosa and clinical pouchitis. Methods:
Of the consecutive 81 UC patients treated with restorative proctocolec
tomy with ileal J reservoir at Tampere University Hospital between 198
5 and 1991, 73 with peroperative liver biopsy were included. A peroper
ative liver biopsy was obtained during proctocolectomy. After a median
follow up of 64 months, pouch biopsy specimens were obtained. Periods
of clinical pouchitis were diagnosed by means of clinical criteria al
one or by clinical criteria combined with the results of previous pouc
h endoscopies in all patients. Results: Ten patients (14%) showed hist
ologic features consistent with small-duct PSC on liver biopsy. Endosc
opic retrograde cholangiography had previously been performed on four
of these patients, and all four had large-duct PSC. Patients with chol
angitis had significantly more severe chronic, but not acute, inflamma
tion in the pouch mucosa than patients without cholangitis. At least o
ne episode of pouchitis occurred in 30% of the patients without cholan
gitis as compared with 90% of the patients with cholangitis. Chronic p
ouchitis was more frequent in the group with cholangitis than in the g
roup without it (70% versus 11%). Conclusions: The only means of detec
ting all UC patients with cholangitis is a liver biopsy. Cholangitis,
either with the clinical syndrome of PSC or found on liver biopsy, see
ms to be a risk factor for chronic-type inflammatory changes in the po
uch mucosa and for the development of pouchitis.