Michel Kmeid1, Soe Htet Arker2, Adam Petchers3, Georgi Lukose4, Hua Li5, Edward C Lee6, Cary M Qualia7, Mustafa Erdem Arslan8, Hwajeong Lee9. 1. Department of Pathology and Laboratory Medicine, Albany Medical Center, Albany, NY, USA. Electronic address: kmeidm@amc.edu. 2. Department of Pathology and Laboratory Medicine, Albany Medical Center, Albany, NY, USA. Electronic address: arkers@amc.edu. 3. Department of Surgery, Albany Medical Center, Albany, NY, USA. Electronic address: petchea@amc.edu. 4. Albany Medical College, Albany, NY, USA. Electronic address: gel9058@nyp.org. 5. Department of Pathology and Laboratory Medicine, Albany Medical Center, Albany, NY, USA. Electronic address: lih4@amc.edu. 6. Department of Surgery, Albany Medical Center, Albany, NY, USA. Electronic address: LeeE@amc.edu. 7. Department of Pediatrics, Albany Medical Center, Albany, NY, USA. Electronic address: QualiaC@amc.edu. 8. Department of Pathology and Laboratory Medicine, Albany Medical Center, Albany, NY, USA. Electronic address: arslanm@amc.edu. 9. Department of Pathology and Laboratory Medicine, Albany Medical Center, Albany, NY, USA. Electronic address: LeeH5@amc.edu.
Abstract
BACKGROUND: Appendiceal inflammation in colectomy is one of the histologic predictors of pouchitis in ulcerative colitis (UC) following ileal pouch anal anastomosis (IPAA). Fecal calprotectin level has been shown to increase 2 months prior to the onset of pouchitis. We evaluated whether inflammation and calprotectin expression in appendiceal specimens correlate with early-onset pouchitis in UC and indeterminate colitis (IC). MATERIALS AND METHODS: IPAA (2000-2018) cases with appendix blocks available in colectomy specimens were identified (n = 93, 90 UC, 3 IC). Histologic features thought to predict pouchitis were evaluated. The degree of appendiceal inflammation was scored. Calprotectin immunostain was performed on the appendix blocks and the extent of mucosal staining was quantified. Electronic medical records were reviewed for demographics, smoking history, clinical pouchitis, time of onset of pouchitis, and clinical and endoscopic components of the Pouchitis Disease Activity Index (PDAI) score. Follow-up pouch biopsies were reviewed and scored to generate histologic PDAI score, when available. RESULTS: Among the patients with clinical pouchitis (n = 73), moderate to severe appendiceal inflammation independently correlated with earlier pouchitis compared to no/mild inflammation (median time to pouchitis 12.0 vs. 23.8, log rank p = 0.016). Calprotectin staining correlated with inflammatory scores of the appendix (Spearman's rho, r = 0.630, p < 0.001) but not with early pouchitis (p > 0.05). CONCLUSIONS: The presence of moderate to severe appendiceal inflammation at the time of colectomy was associated with a shorter time to pouchitis following IPAA. Calprotectin immunostain may be used to demonstrate the presence of inflammation in the appendix but its role in predicting early pouchitis remains limited.
BACKGROUND: Appendiceal inflammation in colectomy is one of the histologic predictors of pouchitis in ulcerative colitis (UC) following ileal pouch anal anastomosis (IPAA). Fecal calprotectin level has been shown to increase 2 months prior to the onset of pouchitis. We evaluated whether inflammation and calprotectin expression in appendiceal specimens correlate with early-onset pouchitis in UC and indeterminate colitis (IC). MATERIALS AND METHODS: IPAA (2000-2018) cases with appendix blocks available in colectomy specimens were identified (n = 93, 90 UC, 3 IC). Histologic features thought to predict pouchitis were evaluated. The degree of appendiceal inflammation was scored. Calprotectin immunostain was performed on the appendix blocks and the extent of mucosal staining was quantified. Electronic medical records were reviewed for demographics, smoking history, clinical pouchitis, time of onset of pouchitis, and clinical and endoscopic components of the Pouchitis Disease Activity Index (PDAI) score. Follow-up pouch biopsies were reviewed and scored to generate histologic PDAI score, when available. RESULTS: Among the patients with clinical pouchitis (n = 73), moderate to severe appendiceal inflammation independently correlated with earlier pouchitis compared to no/mild inflammation (median time to pouchitis 12.0 vs. 23.8, log rank p = 0.016). Calprotectin staining correlated with inflammatory scores of the appendix (Spearman's rho, r = 0.630, p < 0.001) but not with early pouchitis (p > 0.05). CONCLUSIONS: The presence of moderate to severe appendiceal inflammation at the time of colectomy was associated with a shorter time to pouchitis following IPAA. Calprotectin immunostain may be used to demonstrate the presence of inflammation in the appendix but its role in predicting early pouchitis remains limited.
Authors: Mustafa Erdem Arslan; Rupinder Brar; Lianna Goetz; Dipti Karamchandani; Michael W Mikula; Kyle Hodge; Hua Li; Sangtae Ahn; Hwajeong Lee Journal: J Pathol Transl Med Date: 2022-07-04