Mucosal inflammation in the terminal ileum of ulcerative colitis patients: Endoscopic findings and cytokine profiles

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doi:10.1016/j.dld.2007.11.020 Copyright © 2007 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd.

Alimentary Tract

Takayuki Yamamotoa, , , Yasuki Maruyamaa, Satoru Umegaea, Koichi Matsumotoa and Abbi R. Saniabadib aInflammatory Bowel Disease Centre, Yokkaichi Social Insurance Hospital, 10-8 Hazuyamacho, Yokkaichi, Mie 510-0016, JapanbDepartment of Pharmacology, Hamamatsu University, Hamamatsu, Shizuoka, Japan Received 29 July 2007; accepted 26 November 2007. Available online 19 February 2008.

Abstract

Background

Currently, published reports of mucosal inflammation in the terminal ileum of ulcerative colitis (UC) before colectomy are scarce. Aim

To investigate inflammation in the terminal ileum of UC patients by endoscopic examinations and measurement of mucosal cytokine profiles. Methods

Fifty consecutive patients with active UC were studied. At ileocolonoscopy, mucosal biopsies were taken from the terminal ileum. As control, mucosal biopsies from 20 patients without inflammation were examined. Results

Thirty-eight patients showed endoscopically normal terminal ileum, four showed backwash ileitis, and eight showed non-backwash ileitis (ileitis with normal caecum). Pancolitis was observed in all of four patients with backwash ileitis, in 4 of 8 (50%) with non-backwash ileitis, and in 4 of 38 (11%) without ileal inflammation (P = 0.0002). Extraintestinal manifestations were observed in none of 4 patients with backwash ileitis, in 6 of 8 (75%) with non-backwash ileitis, and in 3 of 38 (8%) without ileal inflammation (P < 0.0001). In patients with backwash ileitis and non-backwash ileitis, ileal interleukin [iL]-1β, IL-6, IL-8 and tumour necrosis factor-α levels were significantly elevated compared with the control group. Only extraintestinal manifestation was associated with higher ileal cytokine levels, whereas age, sex, and duration, extent and severity of UC did not show any apparent association. Conclusions

In patients with backwash ileitis, elevated ileal cytokines might reflect a reaction to regurgitation of colonic content into the ileum, but in patients without backwash ileitis, alternative factors are expected to contribute to the aetiology of ileal inflammation. Patients with extraintestinal manifestations had elevated ileal cytokine levels.

Keywords: Backwash ileitis; Cytokine; Extraintestinal manifestations; Immunological reactions; Mucosal inflammation; Terminal ileum; Ulcerative colitis

Corresponding author. Tel.: +81 593 31 2000; fax: +81 593 31 0354.

Digestive and Liver Disease Volume 40, Issue 4, April 2008, Pages 253-259