BACKGROUND: Transmural inflammation shown by imaging and histology has been considered a hallmark of Crohn's disease (CD). However, the diagnostic and prognostic value of this feature in CD of the pouch has not been evaluated. This study aimed to evaluate the clinical utility of transmural inflammation in patients with ileal pouch-anal anastomosis (IPAA) using in vivo optical coherence tomography (OCT) and histopathology. METHODS: All the patients were recruited from the subspecialty Pouchitis Clinic. The study consisted of two parts: (1) a prospective study with in vivo through-the-scope OCT for the evaluation of transmural disease in patients with normal or diseased pouches and (2) a retrospective pathology re-review for transmural inflammation in excised pouch specimens of CD and chronic pouchitis. RESULTS: This prospective OCT study enrolled 53 patients: 11 (20.8%) with normal pouches or irritable pouch syndrome, 10 (18.9%) with acute pouchitis, 11 (20.8%) with chronic antibiotic-refractory pouchitis (CARP), and 21 (39.6%) with CD of the pouch. Transmural inflammation, characterized by the loss of layered structure on OCT, was detected in 16 patients (30.2%): 4 with chronic pouchitis and 12 with CD of the pouch. None of the patients with normal pouches, irritable pouch syndrome, or acute pouchitis had transmural disease shown on OCT. Of the 26 patients with pouch failure who had pouch excision, the surgical specimens showed transmural disease in 30% of the CARP patients (3/10) and 12.5% (2/16) of those with CD of the pouch. CONCLUSIONS: Transmural disease in the setting of IPAA is not pathognomonic of CD. Transmural inflammation shown by imaging or histopathology was seen in both CD and CARP. Transmural inflammation of the pouch appeared to be associated with poor pouch outcome.
BACKGROUND:Transmural inflammation shown by imaging and histology has been considered a hallmark of Crohn's disease (CD). However, the diagnostic and prognostic value of this feature in CD of the pouch has not been evaluated. This study aimed to evaluate the clinical utility of transmural inflammation in patients with ileal pouch-anal anastomosis (IPAA) using in vivo optical coherence tomography (OCT) and histopathology. METHODS: All the patients were recruited from the subspecialty Pouchitis Clinic. The study consisted of two parts: (1) a prospective study with in vivo through-the-scope OCT for the evaluation of transmural disease in patients with normal or diseased pouches and (2) a retrospective pathology re-review for transmural inflammation in excised pouch specimens of CD and chronic pouchitis. RESULTS: This prospective OCT study enrolled 53 patients: 11 (20.8%) with normal pouches or irritable pouch syndrome, 10 (18.9%) with acute pouchitis, 11 (20.8%) with chronic antibiotic-refractory pouchitis (CARP), and 21 (39.6%) with CD of the pouch. Transmural inflammation, characterized by the loss of layered structure on OCT, was detected in 16 patients (30.2%): 4 with chronic pouchitis and 12 with CD of the pouch. None of the patients with normal pouches, irritable pouch syndrome, or acute pouchitis had transmural disease shown on OCT. Of the 26 patients with pouch failure who had pouch excision, the surgical specimens showed transmural disease in 30% of the CARPpatients (3/10) and 12.5% (2/16) of those with CD of the pouch. CONCLUSIONS: Transmural disease in the setting of IPAA is not pathognomonic of CD. Transmural inflammation shown by imaging or histopathology was seen in both CD and CARP. Transmural inflammation of the pouch appeared to be associated with poor pouch outcome.
Authors: Bo Shen; Gregory Zuccaro; Terry L Gramlich; Natalie Gladkova; Bret A Lashner; Conor P Delaney; Jason T Connor; Feza H Remzi; Margaret Kareta; Charles L Bevins; Felix Feldchtein; Scott A Strong; Marlene L Bambrick; Patricia Trolli; Victor W Fazio Journal: Clin Gastroenterol Hepatol Date: 2004-09 Impact factor: 11.382
Authors: Bo Shen; Victor W Fazio; Feza H Remzi; Ana E Bennett; Rocio Lopez; Aaron Brzezinski; Ioannis Oikonomou; Kerry K Sherman; Bret A Lashner Journal: Dis Colon Rectum Date: 2007-04 Impact factor: 4.585
Authors: M V Sivak; K Kobayashi; J A Izatt; A M Rollins; R Ung-Runyawee; A Chak; R C Wong; G A Isenberg; J Willis Journal: Gastrointest Endosc Date: 2000-04 Impact factor: 9.427
Authors: P Gionchetti; F Rizzello; A Venturi; F Ugolini; M Rossi; P Brigidi; R Johansson; A Ferrieri; G Poggioli; M Campieri Journal: Aliment Pharmacol Ther Date: 1999-06 Impact factor: 8.171
Authors: T Kühbacher; S J Ott; U Helwig; T Mimura; F Rizzello; B Kleessen; P Gionchetti; M Blaut; M Campieri; U R Fölsch; M A Kamm; S Schreiber Journal: Gut Date: 2006-01-09 Impact factor: 23.059