ANTINEUTROPHIL CYTOPLASMIC ANTIBODY SUBTYPES IN CHILDREN AND ADOLESCENTS AFTER ILEAL POUCH-ANAL ANASTOMOSIS FOR ULCERATIVE-COLITIS

Background: Perinuclear antineutrophil cytoplasmic antibodies occur fr equently in adult patients with chronic pouchitis after colectomy and ileal pouch-anal anastomosis for ulcerative colitis. The purpose of th e study was to determine the prevalence of perinuclear antineutrophil cytoplasmic antibodies and cytoplasmic antineutrophil cytoplasmic anti body in children and adolescents who undergo colectomy and ileal pouch -anal anastomosis for ulcerative colitis and familial adenomatous poly posis. Methods: Five groups of children and adolescents (age, <20 year s) were studied, with the following histories: acute pouchitis and his tory of ulcerative colitis; chronic pouchitis and history of ulcerativ e colitis; pouchitis with Crohn's disease features and a history of ul cerative colitis; no pouchitis and a history of ulcerative colitis; an d familial adenomatous polyposis, with or without pouchitis. Antineutr ophil cytoplasmic antibody levels and titers were detected in postoper ative sera by enzyme-linked immunosorbent assay, and positive results were subtyped by indirect immunofluorescence. Results: The frequency o f perinuclear antineutrophil cytoplasmic antibodies and cytoplasmic an tineutrophil cytoplasmic antibody in patients with a history of ulcera tive colitis were 67% and 15%, compared with a 0% presence in patients with familial adenomatous polyposis (p < 0.001). There was no signifi cant correlation between the frequency of perinuclear antineutrophil c ytoplasmic antibodies and ulcerative colitis patient subgroups (patien ts with and without pouchitis, 66% and 75%). Similarly, there was no s ignificant correlation between the frequency of cytoplasmic antineutro phil cytoplasmic antibodies among ulcerative colitis patient subgroups (patients with and without pouchitis, 19% and 8%). The frequency of c ytoplasmic antineutrophil cytoplasmic antibody in patients with Crohn' s disease features (50%), was increased, but this difference was not s ignificant. Conclusions: There is a high frequency of perinuclear anti neutrophil cytoplasmic antibodies in children and adolescents who unde rgo ileal pouch-anal anastomosis for ulcerative colitis, whether or no t they have pouchitis. The frequency of cytoplasmic antineutrophil cyt oplasmic antibody is lower in this patient population. Additional stud ies will be required to determine whether the presence of cytoplasmic antineutrophil cytoplasmic antibody is associated with the postoperati ve development of features of Crohn's disease. (C) 1998 Lippincott-Rav en Publishers.