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* = Presenting author

P290 Pre-operative anti-glycan antibodies and anti-glycan antibodies developing after pouch surgery in patients with ulcerative colitis correlate with pouch complications: a prospective longitudinal case series

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

Background

Pouch inflammation is a common complication in patients with ulcerative colitis (UC) undergoing proctocolectomy and ileal pouch anal anastomosis (pouch surgery). Previous data showed similarities in serologic responses, specifically anti-glycan antibodies in patients with a pouch and those with Crohn’s disease (CD). We aimed to assess the prevalence of CD-associated anti-glycan antibodies in patients before and after pouch surgery and to study prospectively their correlation with pouch inflammation.

Methods

Serum samples were collected before and after pouch surgery. Anti-glycan antibodies including anti-Saccharomyces cerevisiae, anti-laminaribioside, anti-chitobioside, and S. S, ALCA, ACCA, and AMCA, respectively) were tested using ELISA.

Results

Overall, 10 patients with UC were recruited and followed-up for 21 ± 25 months after pouch surgery. The first analysis was done 10.42 ± 11.2 months before surgery. For each patient 1–3 serum samples were collected before surgery and 1–3 samples after surgery. Average age at first analysis was 37.6 ± 16.2 years, male gender 6/10, and smokers 2/10. Baseline serologic responses were 24.82 ± 31.2; 28.34 ± 31.6; 33.5 ± 23.6; and 53.0 ± 73 for ASCA, ALCA, ACCA, and AMCA, respectively. Before surgery, 3/10 patients were seropositive (ALCA+, ASCA+, and both ALCA+ & AMCA+). Those 3 patients developed chronic pouchitis during the post-operative follow-up period, during which 2 remained seropositive and 1 turned sero negative. After pouch surgery, 3 more patients turned positive (ASCA+, AMCA+, and both AMCA+ & ACCA+). Thus, 5 (50%) patients were seropositive after pouch surgery. Of the 3 patients, developing after pouch surgery seropositiviety, 2 developed chronic pouchitis and 1 was lost for follow-up 17 months after surgery. None of the 4 patients with a normal pouch during follow-up tested positive pre-operatively to any anti-glycan antibody, and 3/4 patients with normal pouch remained seronegative post-operatively, as well.

Conclusion

Pouch surgery may trigger CD-like immune response to glycans in UC patients, which can be characterised by the de-novo development of anti-glycan antibodies. Pre-operative anti-glycan antibodies, as well as antibodies developing post-operatively, might be associated with an increased risk for pouch complications. Pre-operative seronegativity might be associated with lower risk for pouch inflammation. Thus, serologic markers might assist in determining the prognosis in patients with a pouch.