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. 2022 Nov 27;12(1):20361.
doi: 10.1038/s41598-022-24708-2.

Inflammatory bowel disease-specific findings are common morphological changes in the ileal pouch with ulcerative colitis

Kenichiro Toritani  1   2 , Hideaki Kimura  3 , Masako Otani  4 , Hironori Fukuoka  1 , Reiko Kunisaki  2 , Jun Watanabe  5 , Atsushi Ishibe  1 , Toshihiro Misumi  6 , Yoshiaki Inayama  4 , Itaru Endo  1
Affiliations

Inflammatory bowel disease-specific findings are common morphological changes in the ileal pouch with ulcerative colitis

Kenichiro Toritani et al. Sci Rep. .

Abstract

Why inflammation is common in ileal pouches with ulcerative colitis (UC) is unclear. We therefore clarified the morphological changes in pouches and afferent limbs (AL) of patients with UC and explored the relationship between these findings. We evaluated the morphological findings (histological and endoscopic inflammation as the Pouchitis Disease Activity Index [PDAI] histology subscore [hPDAI] and endoscopy subscore [ePDAI], inflammatory bowel disease [IBD]-specific findings using the IBD score [SIBD], colonic metaplasia using the colonic metaplasia score [CMS], and goblet cell [GC] ratio) in the pouch and AL of patients with UC. A total of 261 pouchoscopies were analyzed. The pouch body had a higher hPDAI (p < 0.001), SIBD (p < 0.001), CMS (p < 0.001), GC ratio (p < 0.001), and ePDAI (p < 0.001) than the AL. The hPDAI was correlated with the SIBD (Spearman's coefficient r = 0.538; p < 0.001), CMS (r = 0.687; p < 0.001), and the ePDAI (r = 0.552; p < 0.001), but not with GC ratio (r = 0.175; p < 0.001) or the pouch usage duration (r = -0.057; p = 0.107). The incidence of histological inflammation was higher in specimens showing basal plasmacytosis with severe mononuclear cell infiltration (BP) than in those without BP (odds ratio [OR] 6.790, p < 0.001), BP was commonly found with crypt hyperplasia (OR 3.414, p < 0.001) and the crypt length correlated with neutrophil infiltration (r = 0.469; p < 0.001). Histological inflammation, colonic metaplasia, the GC ratio, endoscopic inflammation, and IBD-specific findings were commonly present in the pouch than in the AL. Histological inflammation occurs with IBD-specific findings and colonic metaplasia, and these signify endoscopic inflammation.

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Conflict of interest statement

Hideaki Kimura reports receiving personal fees from Mitsubishi Tanabe Pharma, EA Pharma, ZERIA Pharmaceuticals and Janssen Pharmaceuticals while conducting the study. Reiko Kunisaki reports receiving research grants or personal fees from AbbVie GK, Janssen Pharmaceutical K.K., JIMRO Co,. Ltd, Kyorin Pharmaceutical Co., Ltd, Kyowa Hakko Kirin Co., Ltd, Nippon Kayaku Co.,Ltd, Mitsubishi Tanabe Pharma Corporation, Takeda Pharma Co Ltd and Zeria Pharmaceutical Co. Ltd while conducting the study. Jun Watanabe reports receiving honoraria for lectures from Johnson and Johnson, Medtronic and Eli Lilly, and receiving research funding from Medtronic, AMCO and TERUMO outside the submitted work. Itaru Endo reports receiving personal fees from ASAHI KASEI PHARMA CORPORATION while conducting the study. Kenichiro Toritani, Masako Otani, Hironori Fukuoka, Atsushi Ishibe, Toshihiro Misumi, and Yoshiaki Inayama have no financial disclosures or conflicts of interest.

Figures

Figure 1
Figure 1
Typical cases of AL, PP and DP. 32 years-old, male, 1.3 years after the pouch usage. cPDAI = 0 (no symptoms). (A) AL, ePDAI = 0, hPDAI = 0, CMS = 1, SIBD = 2, Goblet cell rate = 14. (B) PP, ePDAI = 2, hPDAI = 2, CMS = 3, SIBD = 4, Goblet cell rate = 23. (C) DP, ePDAI = 2, hPDAI = 3, CMS = 4, SIBD = 4, Goblet cell rate = 35. hPDAI-pouchitis disease activity index histology subscore; CMS-colonic metaplasia scores; SIBD-the IBD score.
Figure 2
Figure 2
Correlation between CMS and SIBD. The crypt length correlated with the SIBD [A; r = 0.505; p < 0.001], the villus length did not correlate with the SIBD [B; r = −0.293; p < 0.001]. CMS-colonic metaplasia scores; SIBD-the IBD score.
Figure 3
Figure 3
Correlation between findings of hPDAI and CMS. Neutrophil infiltration did not correlated with villus length [A; Spearman’s coefficient r = −0.367; p < 0.001], but did correlated with crypt length [B; r = 0.469; p < 0.001]. Ulceration showed an inverse correlation with villi length [C; r = −0.659; p < 0.001], but not with crypt length [D; r = 0.362; p < 0.001]. hPDAI-pouchitis disease activity index histology subscore; CMS-colonic metaplasia scores.
Figure 4
Figure 4
Outline of patient selection. UC-Ulcerative colitis; AL-afferent limbs.
See this image and copyright information in PMC

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