Biancone L, Calabrese E, Palmieri G, Petruzziello C, Onali S, Sica GS, Cossignani M, Condino G, Das KM, Pallone F. Ileal lesions in patients with ulcerative colitis after ileo-rectal anastomosis: Relationship with colonic metaplasia. World J Gastroenterol 2008; 14(34): 5290-5300 [PMID: 18785281 DOI: 10.3748/wjg.14.5290]
Corresponding Author of This Article
Livia Biancone, MD, PhD, Cattedra di Gastroenterologia, Dipartimento di Medicina Interna, Università“Tor Vergata”, Via Montpellier, 1, Rome 00133, Italy. biancone@med.uniroma2.it
Article-Type of This Article
Clinical Research
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World J Gastroenterol. Sep 14, 2008; 14(34): 5290-5300 Published online Sep 14, 2008. doi: 10.3748/wjg.14.5290
Ileal lesions in patients with ulcerative colitis after ileo-rectal anastomosis: Relationship with colonic metaplasia
Livia Biancone, Emma Calabrese, Giampiero Palmieri, Carmelina Petruzziello, Sara Onali, Giuseppe Sigismondo Sica, Marta Cossignani, Giovanna Condino, Kiron Moy Das, Francesco Pallone
Livia Biancone, Emma Calabrese, Carmelina Petruzziello, Sara Onali, Marta Cossignani, Giovanna Condino, Francesco Pallone, Cattedra di Gastroenterologia, Dipartimento di Medicina Interna, Università di “Tor Vergata”, Roma 00133, Italy
Giampiero Palmieri, Cattedra di Anatomia ed Istologia Patologica, Università di “Tor Vergata”, Roma 00133, Italy
Giuseppe Sigismondo Sica, Cattedra di Chirurgia Generale, Università di “Tor Vergata”, Roma 00133, Italy
Kiron Moy Das, GI Unit, Department of Gastroenterology & Hepatology, University of Medicine & Dentistry of New Brunswick, New Brunswick NJ 08903, United States
Author contributions: Biancone L designed research, performed endoscopies and wrote the paper; Calabrese E, Petruzziello C, Onali S, Condino G performed the clinical assessment and recruitment of patients; Cossignani M performed research and collected the data; Palmieri G performed immunohistochemistry; Sica GS gave his surgical support; Pallone F contributed to writing the paper; Das KM designed research, provided reagents and contributed to wrote the paper.
Supported by The Fondazione Umberto Di Mario, Largo Marchiafava n. 1, ZIP code 00161, Roma, Italy
Correspondence to: Livia Biancone, MD, PhD, Cattedra di Gastroenterologia, Dipartimento di Medicina Interna, Università“Tor Vergata”, Via Montpellier, 1, Rome 00133, Italy. biancone@med.uniroma2.it
Telephone: +39-6-20903737 Fax: +39-6-20903738
Received: May 2, 2008 Revised: June 20, 2008 Accepted: June 27, 2008 Published online: September 14, 2008
Abstract
AIM: To assess whether in ulcerative colitis (UC) patients with ileo-rectal anastomosis (IRA), ileal lesions may develop in the neo-terminal-ileum and their possible relation with phenotypic changes towards colonic epithelium.
METHODS: A total of 19 patients with IRA under regular follow up were enrolled, including 11 UC and 8 controls (6 Crohn’s disease, CD; 1 familial adenomatous polyposis, FAP; 1 colon cancer, colon K). Ileal lesions were identified by ileoscopy with biopsies taken from the ileum (involved and uninvolved) and from the rectal stump. Staining included HE and immunohistochemistry using monoclonal antibodies against colonic epithelial protein CEP (Das-1) and human tropomyosin isoform 5, hTM5 (CG3). Possible relation between development of colonic metaplasia and ileal lesions was investigated.
RESULTS: Stenosing adenocarcinoma of the rectal stump was detected in 1 UC patient. The neo-terminal ileum was therefore investigated in 10/11 UC patients. Ileal ulcers were detected in 7/10 UC, associated with colonic metaplasia in 4/7 (57.1%) and Das-1 and CG3 reactivity in 3/4 UC. In controls, recurrence occurred in 4/6 CD, associated with colonic metaplasia in 3/4 and reactivity with Das-1 and CG3 in 2/3.
CONCLUSION: Present findings suggest that in UC, ileal lesions associated with changes towards colonic epithelium may develop also after IRA. Changes of the ileal content after colectomy may contribute to the development of colonic metaplasia, leading to ileal lesions both in the pouch and in the neo-terminal ileum after IRA.
