Archive | 2019
Extraintestinal Manifestations and Concurrent Autoimmune Disorders in Pouch Patients
Abstract
Abstract Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) remains the treatment of choice for patients with medically refractory ulcerative colitis (UC) or UC with dysplasia. There are risks of complications following IPAA including chronic pouchitis. Chronic pouchitis is associated with extraintestinal manifestations and autoimmune disorders, suggesting overlap in the disease pathogenesis. Pouchitis encompasses a spectrum based on the response or lack of response to antibiotic therapy. There is also emerging evidence of autoimmunity in a subgroup of patients with pouchitis, including patients with concurrent primary sclerosing cholangitis, patients with high serum immunoglobulin G4, or infiltration of immunoglobulin G4-expressing plasma cells in the pouch mucosa. It appears that in a subgroup of patients with chronic antibiotic refractory pouchitis (CARP), there is association with autoimmune factors. It is unclear whether the antibodies play any role in the pathogenesis of CARP or result of an epiphenomenon. However, the presence of these antibodies is useful as biomarkers in identifying patients with immune-mediated pouchitis (IMP), who are thereby more likely to be resistant to standard antibiotic therapy and more likely to respond to immunosuppressive therapies. Further studies are needed to determine if IMP and “non-IMP” types of CARP are distinct clinical entities, and if they are associated with differing clinical outcomes and response to medical therapies.