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The Role of Biomarkers in the Ileal Anal Pouch

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Biomarkers in Inflammatory Bowel Diseases

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Abstract

Restorative proctocolectomy is the procedure of choice in patients with ulcerative colitis refractory to medical therapy and in some patients with familial adenomatous polyposis. Despite overall good long-term function, pouchitis, a nonspecific inflammatory condition in the ileal pouch reservoir, can cause symptoms including increased stool frequency and fluidity, haematochezia, abdominal cramping, urgency and tenesmus, incontinence, fever and extraintestinal manifestations.

Biomarkers to determine pouchitis would ideally be predictive of pouchitis, whilst also being useful as a tool for predicting response and side effects to treatment. There is potential for both serum, faecal and microbial biomarkers which are currently unvalidated. Despite lack of validated biomarkers in pouchitis, CRP, faecal calprotectin and faecal lactoferrin are often used as an adjunct in clinical practice to help guide clinicians. These biomarkers can help predict those that will develop pouchitis and may therefore be useful as a surveillance strategy to enable prompt treatment before symptoms of pouchitis develop.

Despite their potential, no biomarker has been validated for its use in pouchitis, and the studies to date have included small numbers. With the lack of specificity for many biomarkers, thorough investigation of patients with problems with the pouch should include, clinical, biochemical, endoscopic and imaging to rule out other diagnoses that can mimic pouchitis.

The role of biomarkers in pouchitis has potential, with the development of advancing techniques such as metabonomics, metagenomics, metaproteomics and metatranscriptomics, we may be able to find better more sensitive biomarkers to predict and treat pouchitis earlier.

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  1. St Mark’s Hospital, London, UK

    Jonathan P. Segal & Ailsa L. Hart

  2. Department of Surgery and Cancer, Imperial College, London, UK

    Jonathan P. Segal & Ailsa L. Hart

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  1. Jonathan P. Segal
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  1. St Vincent’s Hospital, The University of Melbourne, Melbourne, VIC, Australia

    Nik Sheng Ding

  2. Austin Health, The University of Melbourne, Melbourne, VIC, Australia

    Peter De Cruz

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Segal, J.P., Hart, A.L. (2019). The Role of Biomarkers in the Ileal Anal Pouch. In: Sheng Ding, N., De Cruz, P. (eds) Biomarkers in Inflammatory Bowel Diseases. Springer, Cham. https://doi.org/10.1007/978-3-030-11446-6_14

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