Asymmetric endoscopic inflammation of the ileal pouch: A sign of ischemic pouchitis?

✍ Scribed by Bo Shen; Thomas P. Plesec; Erick Remer; Pokala Kiran; Feza H. Remzi; Rocio Lopez; Victor W. Fazio; John R. Goldblum

• Publisher: John Wiley and Sons
• Year: 2010
• Tongue: English
• Weight: 618 KB
• Volume: 16
• Category: Article
• ISSN: 1078-0998
• DOI: 10.1002/ibd.21129

✦ Synopsis

Background:

Pouchitis is associated with dysbiosis and dysregulated mucosal immunity, although secondary pouchitis with special etiologic factors, such as ischemia, can occur. the aim was to describe a disease phenotype of the ileal pouch with an endoscopic appearance suggestive of ischemia.

Methods:

We identified consecutive patients with endoscopic asymmetric inflammation of the pouch (inflammation of side of the pouch with a completely normal other limb of the pouch one limb and a sharp demarcation along the staple suture line). patients with crohn's disease (cd) of the pouch or antibiotic-responsive pouchitis, matched for duration of the pouch, served as controls. histology slides of mucosal biopsies were re-reviewed independently by 2 blinded gastrointestinal pathologists. demographic, clinical, endoscopic, histologic, and imaging characteristics were compared between the groups.

Results:

Ten patients with "ischemic" pouchitis, 15 with cd of the pouch, and 15 with antibiotic-responsive pouchitis were studied. pyloric gland metaplasia was observed only in the groups with cd of the pouch (23.1%) or antibiotic-responsive pouchitis (13.3%). of patients with "ischemic" pouchitis, 80% had extracellular hemosiderin or hematoidin deposits (versus 30.8% those with cd of the pouch and 13.3% of those with pouchitis, p = 0.003). the majority of patients (80%) with "ischemic" pouchitis did not respond to conventional antibiotic therapy. it appeared that subsequent abdominal surgeries after pouch construction and a history of postoperative portal vein thrombi were associated with "ischemic" pouchitis.

Conclusions:

Endoscopic asymmetric inflammation of the pouch may represent an ischemia-associated pouchitis with characteristic clinical, radiographic, and histologic features. its hemodynamic, cellular, and molecular basis of mechanism warrants further study.