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Dig Dis Sci. 2014 Jan;59(1):135-45. doi: 10.1007/s10620-013-2866-8. Epub 2013 Oct 4.
One of the causes of pouch failure after ileal pouch anal anastomosis (IPAA) for ulcerative colitis (UC) is the development of de novo Crohn's disease (CD). Our aim was to clearly define factors associated with post-IPAA CD.
We conducted a cross-sectional study to compare demographic, clinical, and serological characteristics of patients with and without post-IPAA CD. All subjects underwent testing for anti-neutrophil cytoplasm antibodies, anti-Saccaromyces cerevisiae antibodies, anti-outer membrane porin C antibodies, and anti-CBir1 flagellin (anti-CBir1). A multivariable model assessed factors associated with post-IPAA CD.
Thirty-nine subjects were enrolled in the study: 20 cases and 19 controls. Patients who developed post-IPAA CD were significantly younger (median 22 ± 9.9 vs. 30 ± 11.3, p = .027) at the time of UC diagnosis and exhibited more extraintestinal manifestations compared to controls (p = .023). No significant difference between the groups was found with respect to family history, smoking, duration of illness prior to colectomy, time to the onset of pouchitis, preoperative treatment, and indication for surgery. However, the post-operative serologic profile differed significantly with far more cases having elevated anti-CBir1 titers (p = .016, OR 8.81), the latter being the only independent predictor in the combined model.
Patients with Crohn's disease of the pouch were more likely to have elevated CBir1 antibodies titers than those with simple pouchitis and healthy pouches. The stability of the CBir1 antibodies (pre- and post-colectomy) must be further assessed to establish its value as an independent predictor for development of post-IPAA CD.
回肠贮袋肛管吻合术（IPAA）后发生的贮袋失败的原因之一是新发克罗恩病（CD）的发展。我们的目的是明确与 IPAA 后 CD 相关的因素。
我们进行了一项横断面研究，比较了有和无 IPAA 后 CD 的患者的人口统计学、临床和血清学特征。所有患者均接受了抗中性粒细胞胞质抗体、抗酿酒酵母抗体、抗外膜孔蛋白 C 抗体和抗 CBir1 鞭毛（抗 CBir1）检测。多变量模型评估了与 IPAA 后 CD 相关的因素。
研究纳入了 39 名患者：20 例病例和 19 例对照。发生 IPAA 后 CD 的患者在 UC 诊断时明显更年轻（中位数 22 ± 9.9 岁比 30 ± 11.3 岁，p =.027），并且与对照组相比表现出更多的肠外表现（p =.023）。两组在家族史、吸烟、结肠切除术前疾病持续时间、 pouchitis 发病时间、术前治疗和手术指征方面无显著差异。然而，术后血清学特征存在显著差异，更多的病例抗 CBir1 滴度升高（p =.016，OR 8.81），后者是综合模型中的唯一独立预测因素。
与单纯 pouchitis 和健康贮袋相比，患有 CD 的贮袋患者更有可能出现 CBir1 抗体滴度升高。CBir1 抗体的稳定性（术前和术后）必须进一步评估，以确定其作为 IPAA 后 CD 发展的独立预测因素的价值。
