Patients who were positive for antineutrophil cytoplasmic antibody were more likely to develop chronic pouchitis after total proctocolectomy and ileoanal pouch anastomosis.

Pouchitis is a common and well-known complication of total proctocolectomy and ileoanal pouch anastomosis (IPAA) for inflammatory bowel disease. In some but not all studies, positivity for antineutrophil cytoplasmic antibody (ANCA) has been associated with an increased risk for pouchitis. A link between the anti–Saccharomyces cerevisiae antibody (ASCA) and pouchitis has also been suggested. Now, investigators have conducted a meta-analysis to further investigate possible associations between ANCA or ASCA and acute or chronic pouchitis.

Using a systematic review process, researchers identified 11 studies (8 cohort studies and 3 case-control studies) eligible for the meta-analysis. Acute pouchitis was defined as single episodes that responded to antibiotics. Chronic pouchitis was defined as antibiotic-dependent or antibiotic-refractory pouchitis. In five studies that measured ANCA titers, a high titer was defined as >1:40 in one study and >1:80 in two studies that used indirect immunofluorescence and as >100 EU/mL and >40 EU/mL in two studies that used enzyme-linked immunosorbent assay.

ASCA positivity was not associated with pouchitis. ANCA positivity was not associated with acute pouchitis but was associated with chronic pouchitis in both low and high titers.

CITATION(S):

Singh S et al. Meta-analysis: Serological markers and the risk of acute and chronic pouchitis. Aliment Pharmacol Ther 2013 May; 37:867.