PATTERNS OF DISTRIBUTION OF ENDOSCOPIC AND HISTOLOGICAL-CHANGES IN THE ILEAL RESERVOIR AFTER RESTORATIVE PROCTOCOLECTOMY FOR ULCERATIVE-COLITIS - A LONG-TERM FOLLOW-UP-STUDY

Objective: This study was undertaken to assess the long-term macroscop ic appearance of the ileal reservoir after restorative proctocolectomy for ulcerative colitis, to determine whether there is any correlation between macroscopic and histological changes and whether the distribu tion of these is homogeneous, focal or patchy. Background: No study ha s examined the macroscopic appearance of the ileal reservoir over a lo ng period and it is still unknown to what degree histological changes are diffuse or patchy. Moreover, the relationship between macroscopic and histological changes is poorly understood. Method: Fifty-nine pati ents were examined by one clinician (PSC) 5.3-14.5 years (median 8.2 y ears) postoperatively. A rigid sigmoidoscopy of the reservoir was perf ormed. Four zones in the posterior midline at 5-cm intervals from the ileoanal anastomosis were inspected. At each level a macroscopic score of severity of inflammation was given and a biopsy taken. The degree of acute and chronic inflammation was assessed using a histopathologic al scoring system. Results. All reservoirs showed macroscopic abnormal ities, which were more marked distally in 14 (24%). There was no case in which severity of inflammation was greater in proximal than in dist al zones. Endoscopy overall correlated with both acute and chronic his tological changes. On histological examination the patients could be d ivided into three groups as follows: (1) all four biopsies were normal (group 1, n = 8, 14%), (2) the score of acute and chronic inflammatio n decreased from distal to proximal zones (group 2, n=25, 42%) and (3) all four biopsies were abnormal with the same score (group 3, it = 26 , 44%). The latter group significantly correlated with a present or pa st history of pouchitis. Conclusion: The study has shown that when the re is a gradation of inflammation within the ileal reservoir this is m ore severe in distal than in proximal zones.