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Immunoglobulin G and albumin levels in whole gut lavage fluid provide an objective measure of pouch ileitis

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Background: Gut protein loss is a characteristic of inflammatory bowel disease (IBD), and immunoglobulin (Ig) G, albumin and α1-antitrypsin concentrations in whole gut lavage fluid (WGLF) correlate with clinical disease activity. If inflammation in ileoanal pouches is similar to IBD, then measurement of protein-losing enteropathy by analysis of WGLF may provide an objective assessment of disease activity in pouches.

Methods: Forty-two patients who had restorative proctocolectomy for ulcerative colitis underwent whole gut lavage with a polyethylene glycol–electrolyte solution. The first clear effluent was filtered, processed by the addition of protease inhibitors and stored at - 70°C. IgG, albumin and α1-antitrypsin were assayed in WGLF. The Pouchitis Disease Activity Index (PDAI) was calculated after pouchoscopy and biopsy; the Moskowitz criteria for pouchitis were also applied.

Results: There was a significant correlation of the pouchoscopy score and the PDAI with the concentration of WGLF IgG. All patients with ‘pouchitis’ according to the Moskowitz criteria had a WGLF IgG concentration greater than 10 g/ml. The WGLF albumin level also showed a significant correlation with the PDAI, but α1-antitrypsin concentration did not.

Conclusion: Analysis of WGLF for IgG and albumin may be useful in the assessment of disease activity in pouch inflammation.

Presented to the Surgical Research Society, Oxford, UK, January 1996 and published in abstract form as Br J Surg 1996; 83: 693
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Document Type: Research Article

Publication date: June 1, 2000

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