Risk of cancer in patients with chronic pouchitis after restorative proctocolectomy for ulcerative colitis

• Published in: Colorectal disease 2011-01, Vol.13 (1), p.58-66
• Main Authors: Vento, P., Lepistö, A., Kärkkäinen, P., Ristimäki, A., Haglund, C., Järvinen, H. J.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Biopsy; Chronic Disease; Chronic pouchitis; Colitis, Ulcerative - surgery; Colorectal Neoplasms - epidemiology; COX-2; Cyclooxygenase 2 - analysis; dysplasia; Female; Flow Cytometry; Humans; Immunoenzyme Techniques; Ki-67; Ki-67 Antigen - analysis; Male; Middle Aged; Pouchitis - surgery; Proctocolectomy, Restorative; Risk Factors; Statistics, Nonparametric; Tumor Suppressor Protein p53 - analysis; United Kingdom - epidemiology
• ISSN: 1462-8910; 1463-1318
• DOI: 10.1111/j.1463-1318.2009.02058.x

Aim  The aim of this study was to evaluate the consequences of chronic pouchitis after restorative proctocolectomy for ulcerative colitis. Method  Forty‐two patients with chronic pouchitis underwent pouch endoscopy with biopsies after a median of 8.3 years of postoperative follow up. The pouchitis disease activity index (PDAI) was calculated. Morphological changes were recorded. Immunohistochemical analyses for cyclooxygenase 2 (COX‐2), Ki‐67 and p53 were performed, as was DNA flow cytometry. Endoscopy was also carried out in 10 patients without pouchitis and in nine healthy subjects. Results  In patients with chronic pouchitis, the PDAI was 6 (standard error of the mean ± 4). Eighteen (43%) patients used continuous medication. The PDAI correlated positively with villous atrophy (P