Intest Res.  2024 Jan;22(1):92-103. 10.5217/ir.2023.00105.

Association of colonic metaplasia of goblet cells and endoscopic phenotypes of the J pouch in patients with ulcerative colitis: a retrospective pilot study

• Akiyama S
• Onoda T
• Moue S
• Sakamoto N
• Sakamoto T
• Suzuki H
• Enomoto T
• Matsubara D
• Oda T
• Tsuchiya K

• KMID: 2551282
• DOI: http://doi.org/10.5217/ir.2023.00105

Abstract

Background/Aims
Mucosal adaptation of the ileum toward colonic epithelium has been reported in pouchitis in ulcerative colitis (UC); however, the clinical characteristics, endoscopic findings, and outcomes in patients with pouchitis with ileal mucosal adaptation are poorly understood.
Methods
This was a single-center retrospective study comprising UC patients treated by proctocolectomy with ileal pouch-anal anastomosis who had undergone pouchoscopy at the University of Tsukuba Hospital between 2005 and 2022. Endoscopic phenotypes were evaluated according to the Chicago classification. High-iron diamine staining (HID) was performed to identify sulfomucin (colon-type mucin)-producing goblet cells (GCs) in pouch biopsies. We compared clinical data between patients with (high HID group) and without > 10% sulfomucin-producing GCs in at least one biopsy (low HID group).
Results
We reviewed 390 endoscopic examination reports from 50 patients. Focal inflammation was the most common phenotype (78%). Five patients (10%) required diverting ileostomy. Diffuse inflammation and fistula were significant risk factors for diverting ileostomy. The median proportion of sulfomucin-producing GCs on histological analysis of 82 pouch biopsies from 23 patients was 9.9% (range, 0%–93%). The duration of disease was significantly greater in the high HID group compared to the low HID group. The median percentage of sulfomucin-producing GCs was significantly higher in patients with diffuse inflammation or fistula compared to other endoscopic phenotypes (14% vs. 6.0%, P= 0.011).
Conclusions
Greater proportions of sulfomucin-producing GCs were observed in endoscopic phenotypes associated with poor outcomes in UC, indicating patients with pouchitis showing colonic metaplasia of GCs may benefit from early interventions.

Keyword

Phenotype; Ulcerative colitis; Pouchitis; Sulfomucin: Goblet cells

Figure

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  Fig. 1. Kaplan-Meier curves for pouch survival. (A) All participants and patients with (B) afferent limb (AL) involvement, (C) inlet (IL) involvement, (D) diffuse inflammation of the pouch body, (E) focal inflammation of the pouch body, (F) cuffitis, and (G) pouch fistula.

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  Fig. 2. Comparison of high-iron diamine positive (HID+) goblet cells between phenotypes with favorable and poor outcomes. (A) Boxand- whisker plot showing the proportion of sulfomucin-producing (HID+) goblet cells in J pouch biopsies from patients with ulcerative colitis. (B) Box-and-whisker plots comparing the proportion of sulfomucin-producing (HID+) goblet cells between samples obtained from patients with endoscopic phenotypes associated with poor outcomes (diffuse inflammation of the pouch body or pouch fistula) and from patients with other endoscopic phenotypes.

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  Fig. 3. Representative endoscopic image and high-iron diamine (HID) staining. (A) Representative endoscopic image of focal inflammation of the pouch body and (B) corresponding biopsy demonstrating almost all goblet cells were negative for HID staining (scale bar=200 μm). (C) Representative endoscopic image of diffuse inflammation of the pouch body and (D) corresponding biopsy demonstrating more than 60% of goblet cells were positive for HID (scale bar=200 μm).

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