TY - JOUR
T1 - Histopathology of Colectomy Specimens Predicts Endoscopic Pouch Phenotype in Patients with Ulcerative Colitis
AU - Akiyama, Shintaro
AU - Ollech, Jacob E.
AU - Traboulsi, Cindy
AU - Rai, Victoria
AU - Glick, Laura R.
AU - Yi, Yangtian
AU - Runde, Joseph
AU - Olivas, Andrea D.
AU - Weber, Christopher R.
AU - Cohen, Russell D.
AU - Olortegui, Kinga B.Skowron
AU - Hurst, Roger D.
AU - Umanskiy, Konstantin
AU - Shogan, Benjamin D.
AU - Rubin, Michele A.
AU - Dalal, Sushila R.
AU - Sakuraba, Atsushi
AU - Pekow, Joel
AU - Chang, Eugene B.
AU - Hart, John
AU - Hyman, Neil H.
AU - Rubin, David T.
N1 - Funding Information:
SA, JEO, VR, LRG, YY, CT, JR, ADO, CRW, KSO, RDH, KU, BDS, NHH, AS, and JH have no relevant disclosures. RDC is on the speaker’s bureau from AbbVie and Takeda. He is a consultant/advisor for AbbVie Laboratories, BM/celgene, Eli Lilly, Gilead Sciences, Janssen, Pfizer, Takeda, UCB Pharma. He has received clinical trial support/grants from Abbvie, BMS/Celgene, Boehringer Ingelheim, Crohn’s and Colitis Foundation of America, Genentech, Gilead Sciences, Hollister, Medimmune, Mesoblast Ltd., Osiris Therpeutics, Pfizer, Receptos, RedHill Biopharma, Sanofi-Aventis, Schwarz Pharma, Seres Therapeutics, Takeda Pharma, UCB Pharma. His wife is on the board of directors of Aerpio Theraoeutics, Novus Therapeutics, Vital Therapeutics, Inc, and NantKwest. MAR has served as a consultant for Pfizer. SRD has served as a consultant for Pfizer and is on the speaker’s bureau for AbbVie. JP has received grant support from AbbVie and Takeda. He has served as a consultant for Veraste,. CVS Caremark and is on the advisory board for Takeda, Janssen and Pfizer. EBC is the founder and chief medical officer of AVnovum Therapeutics DTR has received grant support from Takeda; and has served as a consultant for Abbvie, Abgenomics, Allergan Inc., Arena Pharmaceuticals, Bellatrix Pharmaceuticals, Boehringer Ingelheim Ltd., Bristol-Myers Squibb, Celgene Corp/Syneos, Check-cap, Dizal Pharmaceuticals, GalenPharma/Atlantica, Genentech/Roche, Gilead Sciences, Ichnos Sciences S.A., InDex Pharmaceuticals, Iterative Scopes, Janssen Pharmaceuticals, Lilly, Materia Prima, Narrow River Mgmt, Pfizer, Prometheus Laboratories,Reistone, Takeda, and Techlab Inc. He is also co-founder of Cornerstones Health, Inc. and GoDuRn, LLC; on the Board of Trustees of the American College of Gastroenterology.
Funding Information:
Funding in part provided by NIDDK P30 DK42086, NIDDK RC2 DK122394, and the GI Research Foundation of Chicago.
Funding Information:
The authors thank funding in part provided by NIDDK P30 DK42086, NIDDK RC2 DK122394, and the GI Research Foundation of Chicago
Publisher Copyright:
© 2022, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
PY - 2022
Y1 - 2022
N2 - Background: The endoscopic appearance in patients with “pouchitis” after ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC) can be quite heterogenous. Patients with an endoscopic phenotype resembling Crohn’s disease (CD) are at high risk of pouch loss. Aims: We aimed to assess how the histopathology of colectomy specimens predicts endoscopic pouch phenotypes in UC. Methods: We retrospectively assessed pouchoscopies from patients with UC who underwent IPAA and classified pouch findings into 7 main phenotypes: (1) normal, (2) afferent limb involvement, (3) inlet involvement, (4) diffuse, (5) focal inflammation of the pouch body, (6) cuffitis, and (7) pouch with fistulas noted ≥ 6 months from ileostomy takedown. We assessed the clinical and pathological data including deep, focal inflammation, granulomas, and terminal ileal involvement in the colectomy specimens. Logistic regression analysis was performed to identify contributing factors to each phenotype. Results: This study included 1,203 pouchoscopies from 382 patients with UC. On multivariable analysis, deep inflammation was significantly associated with pouch fistulas (Odds ratio 3.27; 95% confidence interval 1.65–6.47; P = 0.0007). Of the 75 patients with deep inflammation, only two patients (2.7%) were diagnosed with CD based on pathology review. Terminal ileal involvement significantly increased the risk of afferent limb involvement (Odds ratio 2.96; 95% confidence interval 1.04–8.47; P = 0.04). There were no significant associations between other microscopic features and phenotypes. Conclusions: We identify histologic features of colectomy specimens in UC that predict subsequent pouch phenotypes. Particularly, deep inflammation in the resected colon was significantly associated with pouch fistulas, a pouch phenotype with poor prognosis.
AB - Background: The endoscopic appearance in patients with “pouchitis” after ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC) can be quite heterogenous. Patients with an endoscopic phenotype resembling Crohn’s disease (CD) are at high risk of pouch loss. Aims: We aimed to assess how the histopathology of colectomy specimens predicts endoscopic pouch phenotypes in UC. Methods: We retrospectively assessed pouchoscopies from patients with UC who underwent IPAA and classified pouch findings into 7 main phenotypes: (1) normal, (2) afferent limb involvement, (3) inlet involvement, (4) diffuse, (5) focal inflammation of the pouch body, (6) cuffitis, and (7) pouch with fistulas noted ≥ 6 months from ileostomy takedown. We assessed the clinical and pathological data including deep, focal inflammation, granulomas, and terminal ileal involvement in the colectomy specimens. Logistic regression analysis was performed to identify contributing factors to each phenotype. Results: This study included 1,203 pouchoscopies from 382 patients with UC. On multivariable analysis, deep inflammation was significantly associated with pouch fistulas (Odds ratio 3.27; 95% confidence interval 1.65–6.47; P = 0.0007). Of the 75 patients with deep inflammation, only two patients (2.7%) were diagnosed with CD based on pathology review. Terminal ileal involvement significantly increased the risk of afferent limb involvement (Odds ratio 2.96; 95% confidence interval 1.04–8.47; P = 0.04). There were no significant associations between other microscopic features and phenotypes. Conclusions: We identify histologic features of colectomy specimens in UC that predict subsequent pouch phenotypes. Particularly, deep inflammation in the resected colon was significantly associated with pouch fistulas, a pouch phenotype with poor prognosis.
KW - Chicago classification of pouchitis
KW - Colectomy specimens
KW - Deep inflammation
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U2 - 10.1007/s10620-022-07405-y
DO - 10.1007/s10620-022-07405-y
M3 - Article
C2 - 35288827
AN - SCOPUS:85126248605
JO - Digestive Diseases and Sciences
JF - Digestive Diseases and Sciences
SN - 0163-2116
ER -