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. 1993 Jan;34(1):101–105. doi: 10.1136/gut.34.1.101

Distribution of mucosal pathology and an assessment of colonic phenotypic change in the pelvic ileal reservoir.

N A Shepherd 1, C J Healey 1, B F Warren 1, P I Richman 1, W H Thomson 1, S P Wilkinson 1
PMCID: PMC1374109  PMID: 8381756

Abstract

The mucosa of the pelvic ileal reservoir undergoes adaptive changes--inflammatory, architectural, and metaplastic--on exposure to the faecal stream. Twenty three quadruple loop ileal pouches constructed for ulcerative colitis (20 patients) and familial adenomatous polyposis (FAP) (three patients) were studied. No patient fulfilled clinical, endoscopic, or histopathological criteria for pouchitis. Standard duplicate biopsy specimens were taken from the proximal limb, the anterior wall, the posterior wall, and the body of the reservoir. An established scoring system was used and showed a highly significant increase in inflammatory scores in posterior wall biopsy specimens compared with those from the anterior wall. These results suggest that the adaptive changes are the direct result of contact with static faecal contents. One patient only showed significant inflammation in the proximal limb. There was no evidence of mucosal prolapse in any anterior wall biopsy specimen. Patients with colitis showed substantially more inflammatory and architectural changes than those with FAP. Ninety six per cent of pouches showed some colonic phenotypic expression as defined by mucin histochemical and PR 3A5 immunohistochemical studies. Our results suggest, however, that there may not be complete colonic metaplasia and that the mucin changes and other phenotypic alterations may represent a non-specific response to pouch inflammation and not a prerequisite for the development of pouchitis. The focal nature of the inflammatory and architectural changes, which may be the result of direct contact with static faecal residue, are clearly shown. A single random biopsy specimen of pouch mucosa is of limited value in assessing pathological changes and screening for potential neoplastic change within the reservoir.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Beart R. W., Jr, Fleming C. R., Banks P. M. Tubulovillous adenomas in a continent ileostomy after proctocolectomy for familial polyposis. Dig Dis Sci. 1982 Jun;27(6):553–556. doi: 10.1007/BF01296737. [DOI] [PubMed] [Google Scholar]
  2. Helander K. G., Ahren C., Philipson B. M., Samuelsson B. M., Ojerskog B. Structure of mucosa in continent ileal reservoirs 15 to 19 years after construction. Hum Pathol. 1990 Dec;21(12):1235–1238. doi: 10.1016/s0046-8177(06)80036-5. [DOI] [PubMed] [Google Scholar]
  3. Löfberg R., Liljeqvist L., Lindquist K., Veress B., Reinholt F. P., Tribukait B. Dysplasia and DNA aneuploidy in a pelvic pouch. Report of a case. Dis Colon Rectum. 1991 Mar;34(3):280–284. doi: 10.1007/BF02090171. [DOI] [PubMed] [Google Scholar]
  4. Madden M. V., Farthing M. J., Nicholls R. J. Inflammation in ileal reservoirs: 'pouchitis'. Gut. 1990 Mar;31(3):247–249. doi: 10.1136/gut.31.3.247. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Moskowitz R. L., Shepherd N. A., Nicholls R. J. An assessment of inflammation in the reservoir after restorative proctocolectomy with ileoanal ileal reservoir. Int J Colorectal Dis. 1986 Jul;1(3):167–174. doi: 10.1007/BF01648445. [DOI] [PubMed] [Google Scholar]
  6. Nicholls R. J., Belliveau P., Neill M., Wilks M., Tabaqchali S. Restorative proctocolectomy with ileal reservoir: a pathophysiological assessment. Gut. 1981 Jun;22(6):462–468. doi: 10.1136/gut.22.6.462. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Nicholls R. J., Pezim M. E. Restorative proctocolectomy with ileal reservoir for ulcerative colitis and familial adenomatous polyposis: a comparison of three reservoir designs. Br J Surg. 1985 Jun;72(6):470–474. doi: 10.1002/bjs.1800720622. [DOI] [PubMed] [Google Scholar]
  8. Nilsson L. O., Kock N. G., Lindgren I., Myrvold H. E., Philipson B. M., Ahrén C. Morphological and histochemical changes in the mucosa of the continent ileostomy reservoir 6--10 years after its construction. Scand J Gastroenterol. 1980;15(6):737–747. doi: 10.3109/00365528009181524. [DOI] [PubMed] [Google Scholar]
  9. O'Connell P. R., Rankin D. R., Weiland L. H., Kelly K. A. Enteric bacteriology, absorption, morphology and emptying after ileal pouch-anal anastomosis. Br J Surg. 1986 Nov;73(11):909–914. doi: 10.1002/bjs.1800731121. [DOI] [PubMed] [Google Scholar]
  10. Philipson B., Brandberg A, Jagenburg R., Kock N. G., Lager I., Ahrén C. Mucosal morphology, bacteriology, and absorption in intra-abdominal ileostomy reservoir. Scand J Gastroenterol. 1975;10(2):145–153. [PubMed] [Google Scholar]
  11. Richman P. I., Bodmer W. F. Monoclonal antibodies to human colorectal epithelium: markers for differentiation and tumour characterization. Int J Cancer. 1987 Mar 15;39(3):317–328. doi: 10.1002/ijc.2910390309. [DOI] [PubMed] [Google Scholar]
  12. SPICER S. S. The use of various cationic reagents in histochemical differentiation of mucopolysaccharides. Am J Clin Pathol. 1961 Nov;36:393–407. doi: 10.1093/ajcp/36.5.393. [DOI] [PubMed] [Google Scholar]
  13. Shepherd N. A., Hultén L., Tytgat G. N., Nicholls R. J., Nasmyth D. G., Hill M. J., Fernandez F., Gertner D. J., Rampton D. S., Hill M. J. Pouchitis. Int J Colorectal Dis. 1989 Dec;4(4):205–229. doi: 10.1007/BF01644986. [DOI] [PubMed] [Google Scholar]
  14. Shepherd N. A., Jass J. R., Duval I., Moskowitz R. L., Nicholls R. J., Morson B. C. Restorative proctocolectomy with ileal reservoir: pathological and histochemical study of mucosal biopsy specimens. J Clin Pathol. 1987 Jun;40(6):601–607. doi: 10.1136/jcp.40.6.601. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Shepherd N. A. The pelvic ileal reservoir: apocalypse later? BMJ. 1990 Oct 20;301(6757):886–887. doi: 10.1136/bmj.301.6757.886. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Slack J. M. Epithelial metaplasia and the second anatomy. Lancet. 1986 Aug 2;2(8501):268–271. doi: 10.1016/s0140-6736(86)92083-0. [DOI] [PubMed] [Google Scholar]
  17. Stern H., Walfisch S., Mullen B., McLeod R., Cohen Z. Cancer in an ileoanal reservoir: a new late complication? Gut. 1990 Apr;31(4):473–475. doi: 10.1136/gut.31.4.473. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Stryker S. J., Carney J. A., Dozois R. R. Multiple adenomatous polyps arising in a continent reservoir ileostomy. Int J Colorectal Dis. 1987 Feb;2(1):43–45. doi: 10.1007/BF01648998. [DOI] [PubMed] [Google Scholar]
  19. Tytgat G. N., van Deventer S. J. Pouchitis. Int J Colorectal Dis. 1988 Nov;3(4):226–228. doi: 10.1007/BF01660720. [DOI] [PubMed] [Google Scholar]
  20. Warren B. F., Shepherd N. A. The role of pathology in pelvic ileal reservoir surgery. Int J Colorectal Dis. 1992 Jun;7(2):68–75. doi: 10.1007/BF00341289. [DOI] [PubMed] [Google Scholar]
  21. de Silva H. J., Gatter K. C., Millard P. R., Kettlewell M., Mortensen N. J., Jewell D. P. Crypt cell proliferation and HLA-DR expression in pelvic ileal pouches. J Clin Pathol. 1990 Oct;43(10):824–828. doi: 10.1136/jcp.43.10.824. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. de Silva H. J., Millard P. R., Kettlewell M., Mortensen N. J., Prince C., Jewell D. P. Mucosal characteristics of pelvic ileal pouches. Gut. 1991 Jan;32(1):61–65. doi: 10.1136/gut.32.1.61. [DOI] [PMC free article] [PubMed] [Google Scholar]

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