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Excerpt
This study is to determine the mucosal adaptation patterns of pelvic pouches in children who had proctocolectomy for ulcerative colitis. An average of 3 mucosal biopsy specimens were obtained from 58 patients during a mean follow-up of 5.25 years (SD=2.44, range 2-12). The mean age at the time of diagnosis was 14.7 years (SD=4.39, range 3-22) and pouch surgery was 18 years(SD= 3.71, range 3-24). Histologic assessment of the degree of villous atrophy as well as acute and chronic inflammation was scored as normal, mild, moderate or severe. The pattern of mucosal adaptation was subsequently categorized as types A (normal mucosa or mild villous atrophy with no or mild inflammation). B (A transient atrophic response with temporary moderate inflammation followed by normalization of architecture) and C (constant atrophy with severe inflammation) according to the previously reported criteria (Veress 1995). In our cohort, the patterns of mucosal adaptation, type A (56.8%,n=33), B(32.7%,n=19) and C (10.3%,n=6) were comparable to that reported in adults. All biopsies were negative for dysplasia. The rate of pouch failure and diagnosis of Crohn's disease were similar in each group and not related to the adaptive pattern. All the patients with type C had chronic clinical pouchitis requiring chronic antibiotic therapy.
We conclude that chronic mucosal atrophy is associated with recurrent clinical pouchitis. The pattern of mucosal adaptation is not associated with rediagnosis of Crohn's disease or pouch failure necessitating ileostomy. Further follow-up is required to determine the significance of these changes with regard to the risk of developing neoplasia in the pouch in patients who have pouch surgery at a young age.
