Both Preoperative Perinuclear Antineutrophil Cytoplasmic Antibody and Anti-CBir1 Expression in Ulcerative Colitis Patients Influence Pouchitis Development After Ileal Pouch-Anal Anastomosis

Phillip Fleshner, Andrew Ippoliti, Marla Dubinsky, Eric Vasiliauskas, Ling Mei, Konstantinos Papadakis, Jerome I. Rotter, Carol Landers, Stephan Targan

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Abstract

Background & Aims: Acute pouchitis (AP) and chronic pouchitis (CP) are common after ileal pouch-anal anastomosis (IPAA) for ulcerative colitis. The aim of this study was to assess associations of preoperative perinuclear antineutrophil cytoplasmic antibody (pANCA) and anti-CBir1 flagellin on AP or CP development. Methods: Patients were assessed prospectively for clinically and endoscopically proven AP (antibiotic responsive) or CP (antibiotic-dependent or refractory to antibiotic therapy). Sera from 238 patients were analyzed for ANCA and anti-CBir1 using an enzyme-linked immunosorbent assay. pANCA+ patients were substratified into high-level (>100 EU/mL) and low-level (<100 EU/mL) groups. Results: After a median follow-up period of 47 months, 72 patients (30%) developed pouchitis. Pouchitis developed in 36% of pANCA+ patients versus 16% of pANCA- patients (P = .005), 46% of anti-CBir1+ patients versus 26% of anti-CBir1- patients (P = .02), and 54% of 35 pANCA+/anti-CBir1+ patients versus 31% of 136 pANCA+/anti-CBir1- patients (P = .02). AP developed in 37 pANCA+ patients (22%) versus 6 pANCA- patients (9%) (P = .02), and 12 anti-CBir1+ patients (26%) versus 31 anti-CBir1- patients (16%) (P = .1). Although AP was not influenced by pANCA level, AP was seen in 38% of low-level pANCA+/anti-CBir1+ patients versus 18% low-level pANCA+/anti-CBir1- patients (P = .03). CP was seen in 29% of high-level pANCA+ patients versus 11% of low-level pANCA+ patients (P = .03). Conclusions: Both pANCA and anti-CBir1 expression are associated with pouchitis after IPAA. Anti-CBir1 increases the incidence of AP only in patients who have low-level pANCA expression, and increases the incidence of CP only in patients who have high-level pANCA expression. Diverse patterns of reactivity to microbial antigens may manifest as different forms of pouchitis after IPAA.

Original languageEnglish (US)
Pages (from-to)561-568
Number of pages8
JournalClinical Gastroenterology and Hepatology
Volume6
Issue number5
DOIs
StatePublished - May 1 2008
Externally publishedYes

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Pouchitis
Colonic Pouches
Antineutrophil Cytoplasmic Antibodies
Ulcerative Colitis
Anti-Bacterial Agents

ASJC Scopus subject areas

  • Gastroenterology

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Both Preoperative Perinuclear Antineutrophil Cytoplasmic Antibody and Anti-CBir1 Expression in Ulcerative Colitis Patients Influence Pouchitis Development After Ileal Pouch-Anal Anastomosis. / Fleshner, Phillip; Ippoliti, Andrew; Dubinsky, Marla; Vasiliauskas, Eric; Mei, Ling; Papadakis, Konstantinos; Rotter, Jerome I.; Landers, Carol; Targan, Stephan.

In: Clinical Gastroenterology and Hepatology, Vol. 6, No. 5, 01.05.2008, p. 561-568.

Research output: Contribution to journalArticle

Fleshner, Phillip ; Ippoliti, Andrew ; Dubinsky, Marla ; Vasiliauskas, Eric ; Mei, Ling ; Papadakis, Konstantinos ; Rotter, Jerome I. ; Landers, Carol ; Targan, Stephan. / Both Preoperative Perinuclear Antineutrophil Cytoplasmic Antibody and Anti-CBir1 Expression in Ulcerative Colitis Patients Influence Pouchitis Development After Ileal Pouch-Anal Anastomosis. In: Clinical Gastroenterology and Hepatology. 2008 ; Vol. 6, No. 5. pp. 561-568.
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title = "Both Preoperative Perinuclear Antineutrophil Cytoplasmic Antibody and Anti-CBir1 Expression in Ulcerative Colitis Patients Influence Pouchitis Development After Ileal Pouch-Anal Anastomosis",
abstract = "Background & Aims: Acute pouchitis (AP) and chronic pouchitis (CP) are common after ileal pouch-anal anastomosis (IPAA) for ulcerative colitis. The aim of this study was to assess associations of preoperative perinuclear antineutrophil cytoplasmic antibody (pANCA) and anti-CBir1 flagellin on AP or CP development. Methods: Patients were assessed prospectively for clinically and endoscopically proven AP (antibiotic responsive) or CP (antibiotic-dependent or refractory to antibiotic therapy). Sera from 238 patients were analyzed for ANCA and anti-CBir1 using an enzyme-linked immunosorbent assay. pANCA+ patients were substratified into high-level (>100 EU/mL) and low-level (<100 EU/mL) groups. Results: After a median follow-up period of 47 months, 72 patients (30{\%}) developed pouchitis. Pouchitis developed in 36{\%} of pANCA+ patients versus 16{\%} of pANCA- patients (P = .005), 46{\%} of anti-CBir1+ patients versus 26{\%} of anti-CBir1- patients (P = .02), and 54{\%} of 35 pANCA+/anti-CBir1+ patients versus 31{\%} of 136 pANCA+/anti-CBir1- patients (P = .02). AP developed in 37 pANCA+ patients (22{\%}) versus 6 pANCA- patients (9{\%}) (P = .02), and 12 anti-CBir1+ patients (26{\%}) versus 31 anti-CBir1- patients (16{\%}) (P = .1). Although AP was not influenced by pANCA level, AP was seen in 38{\%} of low-level pANCA+/anti-CBir1+ patients versus 18{\%} low-level pANCA+/anti-CBir1- patients (P = .03). CP was seen in 29{\%} of high-level pANCA+ patients versus 11{\%} of low-level pANCA+ patients (P = .03). Conclusions: Both pANCA and anti-CBir1 expression are associated with pouchitis after IPAA. Anti-CBir1 increases the incidence of AP only in patients who have low-level pANCA expression, and increases the incidence of CP only in patients who have high-level pANCA expression. Diverse patterns of reactivity to microbial antigens may manifest as different forms of pouchitis after IPAA.",
author = "Phillip Fleshner and Andrew Ippoliti and Marla Dubinsky and Eric Vasiliauskas and Ling Mei and Konstantinos Papadakis and Rotter, {Jerome I.} and Carol Landers and Stephan Targan",
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language = "English (US)",
volume = "6",
pages = "561--568",
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issn = "1542-3565",
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TY - JOUR

T1 - Both Preoperative Perinuclear Antineutrophil Cytoplasmic Antibody and Anti-CBir1 Expression in Ulcerative Colitis Patients Influence Pouchitis Development After Ileal Pouch-Anal Anastomosis

AU - Fleshner, Phillip

AU - Ippoliti, Andrew

AU - Dubinsky, Marla

AU - Vasiliauskas, Eric

AU - Mei, Ling

AU - Papadakis, Konstantinos

AU - Rotter, Jerome I.

AU - Landers, Carol

AU - Targan, Stephan

PY - 2008/5/1

Y1 - 2008/5/1

N2 - Background & Aims: Acute pouchitis (AP) and chronic pouchitis (CP) are common after ileal pouch-anal anastomosis (IPAA) for ulcerative colitis. The aim of this study was to assess associations of preoperative perinuclear antineutrophil cytoplasmic antibody (pANCA) and anti-CBir1 flagellin on AP or CP development. Methods: Patients were assessed prospectively for clinically and endoscopically proven AP (antibiotic responsive) or CP (antibiotic-dependent or refractory to antibiotic therapy). Sera from 238 patients were analyzed for ANCA and anti-CBir1 using an enzyme-linked immunosorbent assay. pANCA+ patients were substratified into high-level (>100 EU/mL) and low-level (<100 EU/mL) groups. Results: After a median follow-up period of 47 months, 72 patients (30%) developed pouchitis. Pouchitis developed in 36% of pANCA+ patients versus 16% of pANCA- patients (P = .005), 46% of anti-CBir1+ patients versus 26% of anti-CBir1- patients (P = .02), and 54% of 35 pANCA+/anti-CBir1+ patients versus 31% of 136 pANCA+/anti-CBir1- patients (P = .02). AP developed in 37 pANCA+ patients (22%) versus 6 pANCA- patients (9%) (P = .02), and 12 anti-CBir1+ patients (26%) versus 31 anti-CBir1- patients (16%) (P = .1). Although AP was not influenced by pANCA level, AP was seen in 38% of low-level pANCA+/anti-CBir1+ patients versus 18% low-level pANCA+/anti-CBir1- patients (P = .03). CP was seen in 29% of high-level pANCA+ patients versus 11% of low-level pANCA+ patients (P = .03). Conclusions: Both pANCA and anti-CBir1 expression are associated with pouchitis after IPAA. Anti-CBir1 increases the incidence of AP only in patients who have low-level pANCA expression, and increases the incidence of CP only in patients who have high-level pANCA expression. Diverse patterns of reactivity to microbial antigens may manifest as different forms of pouchitis after IPAA.

AB - Background & Aims: Acute pouchitis (AP) and chronic pouchitis (CP) are common after ileal pouch-anal anastomosis (IPAA) for ulcerative colitis. The aim of this study was to assess associations of preoperative perinuclear antineutrophil cytoplasmic antibody (pANCA) and anti-CBir1 flagellin on AP or CP development. Methods: Patients were assessed prospectively for clinically and endoscopically proven AP (antibiotic responsive) or CP (antibiotic-dependent or refractory to antibiotic therapy). Sera from 238 patients were analyzed for ANCA and anti-CBir1 using an enzyme-linked immunosorbent assay. pANCA+ patients were substratified into high-level (>100 EU/mL) and low-level (<100 EU/mL) groups. Results: After a median follow-up period of 47 months, 72 patients (30%) developed pouchitis. Pouchitis developed in 36% of pANCA+ patients versus 16% of pANCA- patients (P = .005), 46% of anti-CBir1+ patients versus 26% of anti-CBir1- patients (P = .02), and 54% of 35 pANCA+/anti-CBir1+ patients versus 31% of 136 pANCA+/anti-CBir1- patients (P = .02). AP developed in 37 pANCA+ patients (22%) versus 6 pANCA- patients (9%) (P = .02), and 12 anti-CBir1+ patients (26%) versus 31 anti-CBir1- patients (16%) (P = .1). Although AP was not influenced by pANCA level, AP was seen in 38% of low-level pANCA+/anti-CBir1+ patients versus 18% low-level pANCA+/anti-CBir1- patients (P = .03). CP was seen in 29% of high-level pANCA+ patients versus 11% of low-level pANCA+ patients (P = .03). Conclusions: Both pANCA and anti-CBir1 expression are associated with pouchitis after IPAA. Anti-CBir1 increases the incidence of AP only in patients who have low-level pANCA expression, and increases the incidence of CP only in patients who have high-level pANCA expression. Diverse patterns of reactivity to microbial antigens may manifest as different forms of pouchitis after IPAA.

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U2 - 10.1016/j.cgh.2008.01.002

DO - 10.1016/j.cgh.2008.01.002

M3 - Article

VL - 6

SP - 561

EP - 568

JO - Clinical Gastroenterology and Hepatology

JF - Clinical Gastroenterology and Hepatology

SN - 1542-3565

IS - 5

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