Longterm appraisal of the histological appearances of the ileal reservoir mucosa after restorative proctocolectomy for ulcerative colitis.

Abstract

Between November 1976 and December 1985, 110 patients had restorative proctocolectomy for ulcerative colitis. The histological appearances in the reservoir mucosa were followed up in 60 of 109 survivors over 19-173 months (median 97). The median number of biopsy specimens taken per patient was six with a range of 3-13. These were examined by one pathologist (ICT) unaware of the clinical details using a scoring system previously described to assess the degree of chronic and acute inflammation. There was a significant correlation between the degree of severity of chronic and acute changes (r=0-6192, p<0000001). There was no correlation between the severity of inflammation and the following variables: preoperative duration ofdisease, presence of cancer or dysplasia in the original operative specimen, extra-alimentary manifestations or the type of reservoir. A significant correlation between severe inflammation and male sex was found (p<0.035). The 60 patients could be divided into three groups based on the severity and fluctuation of histological inflammation. In group A (n=27, 450/o) chronic changes were minor and acute inflammation was never seen. In group B (n=25, 42%) chronic changes were more severe and there were transient episodes of acute inflammation. In group C (n=8, 13%) severe chronic and severe acute inflammation were constantly present.

Ileal Pouch Morphology and Microbiology in Ulcerative Colitis Patients

“…These include villous atrophy, increased numbers of intestinal crypts, deepening of intestinal crypts, increased numbers of goblet cells and the development of inflammatory infiltrates of mono-and polynuclear cells [1,2]. These changes in the architecture of the intestinal pouch mucosa were also observed in the present study.…”

“…The pouch is made of the distal part of the ileum; however, it must take on the function of the removed rectum, which is normally responsible for the storage, formation and excretion of stools. This completely new function of the terminal ileum results in significant morphological changes in its mucous membrane: there is gradual villous atrophy and the ileal mucous membrane becomes increasingly similar to the large bowel mucosa (this process is commonly called "colonization" or "colonic metaplasia") [1,2]. This is a prolonged process, lasting a number of years, and may lead to the development of some pathologies which are rather typical for the large bowel.…”

Delay of the First Onset of Pouchitis by Oral Intake of the Probiotic Strain Lactobacillus rhamnosus GG

“…9,18 In 8 to 32 percent of patients with one or more episodes of pouchitis, a syndrome of chronic pouchitis might develop with frequent exacerbations requiring constant maintenance therapy. 4,8,[19][20][21] This chronic pouchitis finally results in pouch excision in 10 percent of these patients. 4,[20][21][22][23] The etiology of pouchitis is still not clear.…”

Is Routine Pouch Surveillance for Dysplasia Indicated for Ileoanal Pouches?

“…These adaptations include villous atrophy, inflammation, metaplasia, and even dysplasia within the pouch, and occur on the molecular level with the expression of sulfated, colonic-type mucin. [1][2][3][4] The amount of inflammation or adaptation has been classified 2,5 into three groups of patients based on the ileal pouch's response. Type A is normal mucosa or mild villous atrophy with no or mild inflammation.…”