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Risk of cancer in patients with chronic pouchitis after restorative proctocolectomy for ulcerative colitis
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 d...
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| Published in: | Colorectal disease 2011-01, Vol.13 (1), p.58-66 |
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| creator | Vento, P. Lepistö, A. Kärkkäinen, P. Ristimäki, A. Haglund, C. Järvinen, H. J. |
| description | 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 |
| doi_str_mv | 10.1111/j.1463-1318.2009.02058.x |
| format | article |
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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 < 0.05). None of the pouch biopsies showed dysplasia. COX‐2 immunostaining was detected in 35 (83.3%) patients with chronic pouchitis, in five (50%) without pouchitis, but in none of the normal controls. COX‐2 expression correlated with mucosal atrophy (P < 0.01). In 15 (35.7%) of 42 patients with chronic pouchitis, Ki‐67 immunostaining was increased, but no increase was observed in either control group (P < 0.002). No p53 immunopositivity was found, and DNA flow cytometry was normal in all pouches. One of the patients developed adenocarcinoma at the anal anastomosis.
Conclusion No dysplastic changes were detected during the first decade after surgery. Routine follow up of patients with chronic pouchitis with a hand‐sewn anastomosis may not be necessary, although a small risk of cancer seems to remain at the anal anastomosis. The follow up should be focused on at‐risk groups.</description><identifier>ISSN: 1462-8910</identifier><identifier>EISSN: 1463-1318</identifier><identifier>DOI: 10.1111/j.1463-1318.2009.02058.x</identifier><identifier>PMID: 19832871</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Publishing Ltd</publisher><subject>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</subject><ispartof>Colorectal disease, 2011-01, Vol.13 (1), p.58-66</ispartof><rights>2010 The Authors. Colorectal Disease © 2010 The Association of Coloproctology of Great Britain and Ireland</rights><rights>2010 The Authors. Colorectal Disease © 2010 The Association of Coloproctology of Great Britain and Ireland.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4078-7eab586a694e843ffc90bac67b1d5b6abfb2eb1205c71b982f48d5c10e0c35a3</citedby><cites>FETCH-LOGICAL-c4078-7eab586a694e843ffc90bac67b1d5b6abfb2eb1205c71b982f48d5c10e0c35a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19832871$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Vento, P.</creatorcontrib><creatorcontrib>Lepistö, A.</creatorcontrib><creatorcontrib>Kärkkäinen, P.</creatorcontrib><creatorcontrib>Ristimäki, A.</creatorcontrib><creatorcontrib>Haglund, C.</creatorcontrib><creatorcontrib>Järvinen, H. J.</creatorcontrib><title>Risk of cancer in patients with chronic pouchitis after restorative proctocolectomy for ulcerative colitis</title><title>Colorectal disease</title><addtitle>Colorectal Dis</addtitle><description>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 < 0.05). None of the pouch biopsies showed dysplasia. COX‐2 immunostaining was detected in 35 (83.3%) patients with chronic pouchitis, in five (50%) without pouchitis, but in none of the normal controls. COX‐2 expression correlated with mucosal atrophy (P < 0.01). In 15 (35.7%) of 42 patients with chronic pouchitis, Ki‐67 immunostaining was increased, but no increase was observed in either control group (P < 0.002). No p53 immunopositivity was found, and DNA flow cytometry was normal in all pouches. One of the patients developed adenocarcinoma at the anal anastomosis.
Conclusion No dysplastic changes were detected during the first decade after surgery. Routine follow up of patients with chronic pouchitis with a hand‐sewn anastomosis may not be necessary, although a small risk of cancer seems to remain at the anal anastomosis. The follow up should be focused on at‐risk groups.</description><subject>Adult</subject><subject>Aged</subject><subject>Biopsy</subject><subject>Chronic Disease</subject><subject>Chronic pouchitis</subject><subject>Colitis, Ulcerative - surgery</subject><subject>Colorectal Neoplasms - epidemiology</subject><subject>COX-2</subject><subject>Cyclooxygenase 2 - analysis</subject><subject>dysplasia</subject><subject>Female</subject><subject>Flow Cytometry</subject><subject>Humans</subject><subject>Immunoenzyme Techniques</subject><subject>Ki-67</subject><subject>Ki-67 Antigen - analysis</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Pouchitis - surgery</subject><subject>Proctocolectomy, Restorative</subject><subject>Risk Factors</subject><subject>Statistics, Nonparametric</subject><subject>Tumor Suppressor Protein p53 - analysis</subject><subject>United Kingdom - epidemiology</subject><issn>1462-8910</issn><issn>1463-1318</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><recordid>eNqNkMtOwzAQRS0E4v0LyDtWCZ48nQ0SFChIBQSqxNKyXVt1SeNiJ9D-PQ6pYIs3M9I9cz1zEcJAYgjvYhFDVqQRpEDjhJAqJgnJabzeQYe_wu5Pn0S0AnKAjrxfEAJFCXQfHUBF04SWcIgWr8a_Y6ux5I1UDpsGr3hrVNN6_GXaOZZzZxsj8cp2cm5a4zHXbQCd8q11Af1UeOWsbK20tQplucHaOtzVwW6Qg9APnqA9zWuvTrf1GE3vbqej-2jyPH4YXU0imZGSRqXiIqcFL6pM0SzVWlZEcFmUAma5KLjQIlECwsGyBFHRRGd0lksgisg05-kxOh9sw1YfXdiSLY2Xqq55o2znGU0gnF8lVSDpQEpnvXdKs5UzS-42DAjrc2YL1sfJ-jhZnzP7yZmtw-jZ9pNOLNXsb3AbbAAuB-DL1Grzb2M2er556NtgEA0Gxrdq_WvA3TsryrTM2dvTmD1Oxq_TyQuw6_QbGWaeZA</recordid><startdate>201101</startdate><enddate>201101</enddate><creator>Vento, P.</creator><creator>Lepistö, A.</creator><creator>Kärkkäinen, P.</creator><creator>Ristimäki, A.</creator><creator>Haglund, C.</creator><creator>Järvinen, H. J.</creator><general>Blackwell Publishing Ltd</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201101</creationdate><title>Risk of cancer in patients with chronic pouchitis after restorative proctocolectomy for ulcerative colitis</title><author>Vento, P. ; Lepistö, A. ; Kärkkäinen, P. ; Ristimäki, A. ; Haglund, C. ; Järvinen, H. J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4078-7eab586a694e843ffc90bac67b1d5b6abfb2eb1205c71b982f48d5c10e0c35a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Biopsy</topic><topic>Chronic Disease</topic><topic>Chronic pouchitis</topic><topic>Colitis, Ulcerative - surgery</topic><topic>Colorectal Neoplasms - epidemiology</topic><topic>COX-2</topic><topic>Cyclooxygenase 2 - analysis</topic><topic>dysplasia</topic><topic>Female</topic><topic>Flow Cytometry</topic><topic>Humans</topic><topic>Immunoenzyme Techniques</topic><topic>Ki-67</topic><topic>Ki-67 Antigen - analysis</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Pouchitis - surgery</topic><topic>Proctocolectomy, Restorative</topic><topic>Risk Factors</topic><topic>Statistics, Nonparametric</topic><topic>Tumor Suppressor Protein p53 - analysis</topic><topic>United Kingdom - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Vento, P.</creatorcontrib><creatorcontrib>Lepistö, A.</creatorcontrib><creatorcontrib>Kärkkäinen, P.</creatorcontrib><creatorcontrib>Ristimäki, A.</creatorcontrib><creatorcontrib>Haglund, C.</creatorcontrib><creatorcontrib>Järvinen, H. J.</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Colorectal disease</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Vento, P.</au><au>Lepistö, A.</au><au>Kärkkäinen, P.</au><au>Ristimäki, A.</au><au>Haglund, C.</au><au>Järvinen, H. J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Risk of cancer in patients with chronic pouchitis after restorative proctocolectomy for ulcerative colitis</atitle><jtitle>Colorectal disease</jtitle><addtitle>Colorectal Dis</addtitle><date>2011-01</date><risdate>2011</risdate><volume>13</volume><issue>1</issue><spage>58</spage><epage>66</epage><pages>58-66</pages><issn>1462-8910</issn><eissn>1463-1318</eissn><abstract>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 < 0.05). None of the pouch biopsies showed dysplasia. COX‐2 immunostaining was detected in 35 (83.3%) patients with chronic pouchitis, in five (50%) without pouchitis, but in none of the normal controls. COX‐2 expression correlated with mucosal atrophy (P < 0.01). In 15 (35.7%) of 42 patients with chronic pouchitis, Ki‐67 immunostaining was increased, but no increase was observed in either control group (P < 0.002). No p53 immunopositivity was found, and DNA flow cytometry was normal in all pouches. One of the patients developed adenocarcinoma at the anal anastomosis.
Conclusion No dysplastic changes were detected during the first decade after surgery. Routine follow up of patients with chronic pouchitis with a hand‐sewn anastomosis may not be necessary, although a small risk of cancer seems to remain at the anal anastomosis. The follow up should be focused on at‐risk groups.</abstract><cop>Oxford, UK</cop><pub>Blackwell Publishing Ltd</pub><pmid>19832871</pmid><doi>10.1111/j.1463-1318.2009.02058.x</doi><tpages>9</tpages></addata></record> |
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| 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 |
| title | Risk of cancer in patients with chronic pouchitis after restorative proctocolectomy for ulcerative colitis |
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