Restorative Proctocolectomy with Ileo-anal Reservoir, a Histopathological, Histochemical, and Electron Microscopic Study

Abstract

This study was conducted to investigate the nature of colonic metaplasia in ileo-anal pouches and incidence / frequency of pouchitis in the same. Biopsy specimens from 8 patients with functioning ileal pouches were studied using routine histology, mucin histochemistry and electron microscopy, over a 2 -year period. All 8 patients had villous abnormalities in the form of blunting of villi and sub total or partial villous atrophy. 6 patients had an increase in the goblet cell population and Paneth cell hyperplasia. These changes were supported by electron microscopic findings of a decrease in number and flattening of ileal type microvilli and their transformed morphologic resemblance to colonic type microvilli. All the ileal pouches also had acquired colorectal type sulphomucin, when sections stained with Alcian-blue and High Iron Diamine -Alcian blue, were studied. However, no case of pouchitis as defined in literature, was found in this study. MJAFI 2003; 59 : 306-309

Endoscopic assessment of the J pouch in ulcerative colitis: A narrative review

“… 46 , 47 There have been reports of ileal mucosal adaptations toward the colonic epithelium, particularly in UC patients suffering from pouchitis. 3 , 48 , 49 , 50 A comparative study evaluating differences between familial adenomatous polyposis and UC pouches revealed that sulfomucin expression was higher in mucous gel from the UC pouches. Additionally, this study demonstrated a correlation between higher expression of sulfomucin and increased colonization of sulfate‐reducing bacteria, 3 implying that colonic metaplasia of GCs may alter the microbial profiles in the pouch and can induce inflammation.…”

Association of colonic metaplasia of goblet cells and endoscopic phenotypes of the J pouch in patients with ulcerative colitis: a retrospective pilot study

“…18 Mucosal adaptations of the ileum toward colonic epithelium have been reported in UC patients with IPAA, particularly in cases of pouchitis. [19][20][21][22] A comparative analysis assessing differences between UC and familial adenomatous polyposis pouches demonstrated sulfomucin expression was greater in mucous gel from the pouch of patients with UC. This study also demonstrated that high expression of sulfomucin was associated with increased colonization of sulfate-reducing bacteria associated with pouch inflammation, 22 indicating that colonic metaplasia of GCs may play an important role in the pathogenesis of pouchitis in UC and may influence disease severity.…”