IgG, albumin, and sCD44 in whole-gut lavage fluid are useful clinical markers for assessing the presence and activity of pouchitis

Pouchitis is the most significant long-term complication in patients with i leoanal pouch anastomosis (IAP) and is especially frequent in patients with ulcerative colitis. There is an urgent need for simple and objective param eters to assess the presence and activity of pouchitis. Whole-gut lavage fl uid (WGLF) was collected from 34 patients [8 with pouchitis (PDAI greater t han or equal to 7 points) and 26 without pouchitis (Pouchitis Disease Activ ity Index, PDAI, <7)]. Patients with active ulcerative colitis (n = 8) serv ed as controls. Concentrations of IgG and sCD44 in WGLF were measured by en zyme-linked immunosorbent assays and those of albumin by immunoturbidimetry . Similar to the case in active ulcerative colitis, concentrations of IgG, albumin, and sCD44 in WGLF were significantly increased in acute pouchitis and reached high specificity (IgG 96%, albumin 96%, sCD44 100%) and accepta ble sensitivity (75%) for the diagnosis of acute pouchitis. These parameter s were also closely correlated with disease activity as determined by PDAI and endoscopic scoring indices. Assay of protein concentrations in WGLF is thus a simple and objective means for grading inflammation of the pouch and may be useful as a quantitative index of disease activity in clinical stud ies.