Abstract
PURPOSE: Variant pathological changes have been observed in ileoanal pouches, including inflammation, villous atrophy, and crypt hyperplasia. Therefore, we investigated the type and degree of mucosal adaptation in patients with ulcerative colitis and familial adenomatous polyposis. METHODS: Forty-two patients with ulcerative colitis and 14 patients with familial adenomatous polyposis with ileoanal pouches were assessed. Samples were taken from three months to eight years after creation of an ileoanal pouch. Mucosal architecture was examined by morphometry after microdissection. RESULTS: Structural changes of the mucosa can be categorized into three groups. Compared with preoperative values, patients without pouchitis (73 percent) has only minor decrease of villous length (402µmvs. 540µm) and increase in crypt depth (274.5µmvs. 177µm). In patients with acute pouchitis (20 percent), a slight increase in villous length (477µmvs. 402µm) and pronounced crypt hyperplasia (376µmvs. 274.5µm) was observed compared with noninflamed ileoanal pouches. In contrast, in patients with chronic pouchitis (7 percent), severe villous atrophy (62.5µm) and crypt hyperplasia (543µm) was found. CONCLUSIONS: Minor structural changes of ileoanal pouch mucosa develop early as an adaptive response to a new environment. Only in a small group of patients with chronic pouchitis does severe villous atrophy and crypt hyperplasia of the ileoanal pouch mucosa develop, most likely as a consequence of mucosal inflammation.
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This work was supported by grants of the Deutsche Forschungsgemeinschaft (Ze 188/4-3) and of the German Crohn's Disease and Ulcerative Colitis Association (DCCV e. V.). Dr. Stallmach is recipient of a Heisenberg professorship of the DFG (Sta 295/3-1).
Presented in part at the Falk, U.K., Workshop, “The Pelvic Ileal Reservoir in Ulcerative Colitis,” Oxford, U.K., April 17 to 19, 1997.
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Stallmach, A., Moser, C., Hero-Gross, R. et al. Pattern of mucosal adaptation in acute and chronic pouchitis. Dis Colon Rectum 42, 1311–1317 (1999). https://doi.org/10.1007/BF02234221
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DOI: https://doi.org/10.1007/BF02234221