Surgical treatment, skin test reactivity, and lymphocytes in inflammatory bowel disease.

Sixty-three patients with inflammatory bowel disease were studied before and after bowel resection. Peripheral lymphocytes, T- and B-cell counts, and skin test reactivity to five recall antigens were determined before operation and 6 to 18 months postoperatively. Twenty-eight patients (44 percent) were unable to react to any skin test initially. Anergic patients had significantly lower lymphocyte and T- and B-cell counts. There was no difference in age, severity or duration of disease, or amount of weight loss between anergic patients and those who responded. Also, there was no difference between patients with ulcerative colitis and those with Crohn's disease. After surgery, 25 previously anergic patients became able to react to skin tests. They also showed a significant increase in T and B cells which did not occur in the previously reactive group. However, the overall peripheral lymphocyte and T- and B-cell counts remained well below those of the normal control subjects. Patients with inflammatory bowel disease that requires surgical treatment have significant immunologic abnormalities. Removal of the diseased bowel, weight gain, and cessation of steroid medication improves skin test reactivity but does not correct the depressed peripheral lymphocyte and especially T-cell counts.