UC pouchitis increases dysplasia risk
MedWire News: Ulcerative colitis (UC) patients who develop pouchitis after restorative proctocolectomy have an increased risk for dysplasia and should undergo regular screening, researchers believe.
"An endoscopy at 5 years using a flexible sigmoidoscope should be the standard procedure," recommend Tomasz Banasiewicz and co-workers, at Poznan University of Medical Sciences in Poland.
"A routine mucosal biopsy allows an evaluation of morphological abnormalities in the pouch, including early recognition of inflammatory lesions and villus atrophy, both of which are risk factors for dysplasia."
The team investigated the relationship between pouch inflammation and dysplasia in 276 UC patients who underwent restorative proctocolectomy between 1984 and 2009. In all, 846 endoscopic biopsy samples from the patients were examined.
As reported in the journal Colorectal Disease, 23.9% of patients had evidence of inflammation, 1.8% had low-grade dysplasia, 1.1% had high-grade dysplasia, and one (0.4%) patient had cancer.
Analysis revealed that patients with inflammation were significantly more likely than those without to have low-grade dysplasia (6.0 vs 0.5%) or high-grade dysplasia (4.5 vs 0.0%).
Furthermore, the risk for dysplasia was significantly and positively linked to the severity of inflammation, with a median Pouchitis Disease Activity Index score of 9.4, 9.6, and 5.4 in patients with low- and high-grade dysplasia, and patients without pouchitis, respectively.
The researchers note that the rate of pouchitis was relatively low in this study, and suggest this may be due to postsurgery exclusion of patients with a subsequent diagnosis of Crohn's disease or early pouch lavage to reduce the risk for inflammation.
Banasiewicz et al recommend that asymptomatic patients begin surveillance for dysplasia 5 years after surgery. "This should probably be performed earlier in patients with any signs of pouchitis although the evidence base to support this statement is weak," they add.
The team concludes: "The optimal surveillance of patients having restorative proctocolectomy is likely to take place in a specialist inflammatory bowel unit composed of gastroenterologists, surgeons, histopathologists, and specialist nurses familiar with the disease and equipped to diagnose dysplasia when it occurs and to take appropriate action."
By Lynda Williams