Meta‐analysis: serological markers and the risk of acute and chronic pouchitis

• Published in: Alimentary pharmacology & therapeutics Vol. 37; no. 9; pp. 867 - 875
• Main Authors: Singh, S., Sharma, P. K., Loftus, E. V., Pardi, D. S.
• Format: Journal Article
• Language: English
• Published: Oxford Blackwell 01.05.2013
• Subjects: Acute Disease; Anal Canal - surgery; Anastomosis, Surgical; Antibodies, Antineutrophil Cytoplasmic - blood; Antibodies, Bacterial - blood; Biological and medical sciences; Biomarkers - blood; Chronic Disease; Colitis, Ulcerative - surgery; Colonic Pouches; Digestive system; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Medical sciences; Pharmacology. Drug treatments; Pouchitis - blood; Pouchitis - etiology; Proctocolectomy, Restorative - adverse effects; Risk Factors; Saccharomyces cerevisiae - immunology; Chronic; Acute; Risk factor; Biological marker; Pouchitis; Serology; Metaanalysis
• ISSN: 0269-2813; 1365-2036
• DOI: 10.1111/apt.12274

Summary Background Serological markers such as anti‐neutrophil cytoplasmic antibody (ANCA) and anti‐Saccharomyces cerevisiae antibody (ASCA) may be associated with pouchitis after ileal pouch‐anal anastomosis (IPAA). Aim To perform a systematic review with meta‐analysis of studies evaluating the association of ANCA and ASCA status with risk of acute and chronic pouchitis after IPAA. Methods We searched multiple databases (upto September 2012) for studies reporting ANCA and/or ASCA status along with risk of acute or chronic pouchitis after IPAA in adults with ulcerative colitis (UC). We ed odds ratio (OR) or raw data from the individual studies to calculate summary OR estimates with 95% CIs using random‐effects model. Results Eight studies reporting 184 cases of acute pouchitis and six studies reporting 151 cases of chronic pouchitis were included. The odds of chronic pouchitis were 76% higher in ANCA‐positive patients than ANCA‐negative (six studies; OR: 1.76; 95% CI: 1.19–2.61; P < 0.01). ASCA‐positivity was not associated with the risk of chronic pouchitis (three studies; OR: 0.89; 95% CI: 0.49–1.59; P = 0.68). Neither ANCA (eight studies; OR: 1.54; 95% CI: 0.79–3.02; P = 0.21) nor ASCA‐positivity (two studies; OR: 1.28; 95% CI: 0.25–6.54; P = 0.77) were associated with the risk of acute pouchitis. Conclusions The risk of chronic pouchitis after IPAA is higher in ANCA‐positive patients, but the risk of acute pouchitis is unaffected by ANCA status. ASCA status was not associated with the risk of acute or chronic pouchitis. This information may be used to counsel UC patients regarding their risk of pouchitis after IPAA.