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Histopathology of Colectomy Specimens Predicts Endoscopic Pouch Phenotype in Patients with Ulcerative Colitis

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A Concise Commentary to this article was published on 14 March 2022

Abstract

Background

The endoscopic appearance in patients with “pouchitis” after ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC) can be quite heterogenous. Patients with an endoscopic phenotype resembling Crohn’s disease (CD) are at high risk of pouch loss.

Aims

We aimed to assess how the histopathology of colectomy specimens predicts endoscopic pouch phenotypes in UC.

Methods

We retrospectively assessed pouchoscopies from patients with UC who underwent IPAA and classified pouch findings into 7 main phenotypes: (1) normal, (2) afferent limb involvement, (3) inlet involvement, (4) diffuse, (5) focal inflammation of the pouch body, (6) cuffitis, and (7) pouch with fistulas noted ≥ 6 months from ileostomy takedown. We assessed the clinical and pathological data including deep, focal inflammation, granulomas, and terminal ileal involvement in the colectomy specimens. Logistic regression analysis was performed to identify contributing factors to each phenotype.

Results

This study included 1,203 pouchoscopies from 382 patients with UC. On multivariable analysis, deep inflammation was significantly associated with pouch fistulas (Odds ratio 3.27; 95% confidence interval 1.65–6.47; P = 0.0007). Of the 75 patients with deep inflammation, only two patients (2.7%) were diagnosed with CD based on pathology review. Terminal ileal involvement significantly increased the risk of afferent limb involvement (Odds ratio 2.96; 95% confidence interval 1.04–8.47; P = 0.04). There were no significant associations between other microscopic features and phenotypes.

Conclusions

We identify histologic features of colectomy specimens in UC that predict subsequent pouch phenotypes. Particularly, deep inflammation in the resected colon was significantly associated with pouch fistulas, a pouch phenotype with poor prognosis.

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Acknowledgments

The authors thank funding in part provided by NIDDK P30 DK42086, NIDDK RC2 DK122394, and the GI Research Foundation of Chicago

Funding

Funding in part provided by NIDDK P30 DK42086, NIDDK RC2 DK122394, and the GI Research Foundation of Chicago.

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Authors and Affiliations

  1. University of Chicago Medicine Inflammatory Bowel Disease Center, 5841 S. Maryland Avenue, MC 4076, Chicago, IL, 60637, USA

    Shintaro Akiyama, Jacob E. Ollech, Cindy Traboulsi, Victoria Rai, Laura R. Glick, Yangtian Yi, Joseph Runde, Andrea D. Olivas, Christopher R. Weber, Russell D. Cohen, Kinga B. Skowron Olortegui, Roger D. Hurst, Konstantin Umanskiy, Benjamin D. Shogan, Michele A. Rubin, Sushila R. Dalal, Atsushi Sakuraba, Joel Pekow, Eugene B. Chang, John Hart, Neil H. Hyman & David T. Rubin

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  1. Shintaro Akiyama
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  2. Jacob E. Ollech
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  3. Cindy Traboulsi
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  4. Victoria Rai
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  15. Michele A. Rubin
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Contributions

SA, EBC, DTR took part in study concept and design; SA, JEO, CT, VR, YY, LRG, JR, ADO, CRW, JH, RDC, KSO, RDH, KU, BDS, NHH, MAR, SRD, AS, JP, DTR involved in acquisition of data; SA, CRW, JH, DTR took part in analysis and interpretation of data; SA, CT, VR, DTR involved in drafting of manuscript; SA, JEO, CT, VR, YY, LRG, JR, ADO, CRW, RDC, KSO, RDH, KU, BDS,NHH, MAR, SRD, AS, JP, EBC, JH, DTR took part in critical revision of manuscript. All authors have approved the final version.

Corresponding author

Correspondence to David T. Rubin.

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Conflict of interest

SA, JEO, VR, LRG, YY, CT, JR, ADO, CRW, KSO, RDH, KU, BDS, NHH, AS, and JH have no relevant disclosures. RDC is on the speaker’s bureau from AbbVie and Takeda. He is a consultant/advisor for AbbVie Laboratories, BM/celgene, Eli Lilly, Gilead Sciences, Janssen, Pfizer, Takeda, UCB Pharma. He has received clinical trial support/grants from Abbvie, BMS/Celgene, Boehringer Ingelheim, Crohn’s and Colitis Foundation of America, Genentech, Gilead Sciences, Hollister, Medimmune, Mesoblast Ltd., Osiris Therpeutics, Pfizer, Receptos, RedHill Biopharma, Sanofi-Aventis, Schwarz Pharma, Seres Therapeutics, Takeda Pharma, UCB Pharma. His wife is on the board of directors of Aerpio Theraoeutics, Novus Therapeutics, Vital Therapeutics, Inc, and NantKwest. MAR has served as a consultant for Pfizer. SRD has served as a consultant for Pfizer and is on the speaker’s bureau for AbbVie. JP has received grant support from AbbVie and Takeda. He has served as a consultant for Veraste,. CVS Caremark and is on the advisory board for Takeda, Janssen and Pfizer. EBC is the founder and chief medical officer of AVnovum Therapeutics DTR has received grant support from Takeda; and has served as a consultant for Abbvie, Abgenomics, Allergan Inc., Arena Pharmaceuticals, Bellatrix Pharmaceuticals, Boehringer Ingelheim Ltd., Bristol-Myers Squibb, Celgene Corp/Syneos, Check-cap, Dizal Pharmaceuticals, GalenPharma/Atlantica, Genentech/Roche, Gilead Sciences, Ichnos Sciences S.A., InDex Pharmaceuticals, Iterative Scopes, Janssen Pharmaceuticals, Lilly, Materia Prima, Narrow River Mgmt, Pfizer, Prometheus Laboratories,Reistone, Takeda, and Techlab Inc. He is also co-founder of Cornerstones Health, Inc. and GoDuRn, LLC; on the Board of Trustees of the American College of Gastroenterology.

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Akiyama, S., Ollech, J.E., Traboulsi, C. et al. Histopathology of Colectomy Specimens Predicts Endoscopic Pouch Phenotype in Patients with Ulcerative Colitis. Dig Dis Sci 67, 4020–4031 (2022). https://doi.org/10.1007/s10620-022-07405-y

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