P258 Prospective follow-up of serologic responses in ulcerative colitis patients with an ileal pouch reveals they are stable over time and do not correlate with the clinical phenotype of the pouch
I. Goren*1, L. Yahav2, H. Tulchinsky3, 4, I. Dotan4, 5
1Tel Aviv medical Centre, IBD Centre, Department of Gastroenterology and Liver Diseases, Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel, 2Tel Aviv Medical Centre, IBD Centre, Department of Gastroenterology and Liver Diseases, Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel, 3Sackler Faculty of Medicine, Tel Aviv Israel, Department of Surgery, Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel, 4Tel Aviv medical Centre, Tel Aviv Israel, Pouch clinic, IBD Centre, Tel Aviv, Israel, 5Sackler Faculty of Medicine, Tel Aviv Israel, IBD Centre, Department of Gastroenterology and Liver Diseases, Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel
Restorative proctocolectomy with ileal pouch anal anastomosis (pouch surgery) is the surgery of choice for patients with refractory or complicated ulcerative colitis (UC). Previous reports suggested that unlike UC patients, serologic responses in patients after pouch surgery were similar to those of patients with Crohn’s disease (CD).Our aim was to investigate whether serologic responses developed over time and their association with clinical phenotype of pouches.
Patients undergoing pouch surgery were prospectively recruited. Pouch phenotype was determined clinically as normal pouch (NP), acute pouchitis/recurrent acute pouchitis (AP/RAP) and chronic pouchitis/Crohn’s-like disease of the pouch (CP/CLDP). Serum samples were obtained periodically including anti-Saccharomyces cerevisiae, anti-laminaribioside, anti-chitobioside, and anti-mannobioside carbohydrate antibodies (ASCA, ALCA, ACCA, and AMCA, respectively). Positive serologic status was defined as ≥ 1 positive serologic response.
Pouch patients (n = 77) were prospectively recruited: mean age 43.9 ± 14.7 years, 58.4% males, time from pouch surgery at first sampling 113.94 ± 78.4 (1–302) months, and time from UC diagnosis 237.9 ± 129.7 (36–540) months. Follow-up duration was 14.05 ± 5.85 (1–28.3) months, and mean number of serologic analyses 2.4 (2–15). The prevalence of positive serology at first serologic analysis was 44.1%. ACCA and AMCA were the most prevalent (20.8% and 23.4%, respectively), whereas ALCA and ASCA, prevalence was 11.7% and 7.8%, respectively. The serologic status (+/-) did not change significantly during follow-up. Levels of AMCA and ASCA did not change significantly (76.3 and 19.4 vs78.2 and 21.6, at first vs last analysis, respectively). However, levels of ACCA and ALCA were modestly changed (median [iqr] -9.12 [-29.5–5.5], p = 0.001) and (median [iqr] 3.8 [-3.4–15.1], p = 0.007), respectively. After correction to follow-up duration, ACCA levels decreased by an average of 1.27 IU/month (CI -2.35 [-0.2], p = 0.02) and ALCA levels increased by an average of 0.5 IU/month (CI 0.1–1.06, p = 0.02). In further sub-group analysis of patients with ‘new’ compared with ‘old’ pouches (≤2 vs ≥10 years from ileostomy closure) serologic responses remained stable. No association was found between serologic status or their level and clinical phenotype of the pouch.
UC patients after pouch surgery have a 44% prevalence of serologic responses characterising CD. Serologic status was independent of pouch clinical phenotype and patients demographics. Serologic status remained generally stable; however, ACCA and ALCA levels significantly change over time. This may reflect specific immune responses to glycans that are ongoing after pouch surgery.