ATYPICAL PERINUCLEAR ANTINEUTROPHIL CYTOPLASMIC ANTIBODIES AFTER-COLECTOMY IN INFLAMMATORY BOWEL-DISEASE

Atypical perinuclear antineutrophil cytoplasmic anti- bodies (p-ANCA) have been detected in most patients with ulcerative colitis and primar y sclerosing cholangitis. Persistent atypical p-ANCA have been observe d in ulcerative colitis patients with a prior proctocolectomy, especia lly with pouchitis, suggesting that this serological marker might be p redictive of subsequent development of chronic or refractory pouchitis . This study prospectively evaluated this serological marker in 24 con secutive patients with inflammatory bowel disease and prior colectomie s (12 with a clinical diagnosis of ulcerative colitis and 12 with a cl inical diagnosis of Crohn's disease involving the colon). Of these, 14 were positive, including 11 with extensive ulcerative colitis and thr ee with Crohn's disease. Although two of three ulcerative colitis pati ents with pouchitis were positive, eight of eight ulcerative colitis p atients having a pelvic pouch with no pouchitis were also positive, as was a patient: who elected to have an end-ileostomy (Brooke's ileosto my). Two patients had abnormal liver chemistry tests. Both had end-sta ge primary sclerosing cholangitis treated with liver transplantation a nd were positive for this serological marker. Although atypical p-ANCA maybe a marker of persistent inflammation in pelvic pouch patients, a positive test result should not be used for prognosis or as a decisio n-making parameter for pelvic pouch procedures.