Tsuyoshi Yanagida; Yu Nishida; Yumie Kobayashi; Rieko Nakata; Shuhei Hosomi; Hirotsugu Maruyama; Masaki Ominami; Yuji Nadatani; Shusei Fukunaga; Koji Otani; Fumio Tanaka; Yasuhiro Fujiwara

doi:10.5217/ir.2024.00170

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Original Article Anti-integrin αvβ6 autoantibody in patients with ulcerative colitis after proctocolectomy: a cross-sectional study in Japan: Tsuyoshi Yanagida, Yu Nishida, Yumie Kobayashi, Rieko Nakata, Shuhei Hosomi^,, Hirotsugu Maruyama, Masaki Ominami, Yuji Nadatani, Shusei Fukunaga, Koji Otani, Fumio Tanaka, Yasuhiro Fujiwara; DOI: https://doi.org/10.5217/ir.2024.00170
Published online: April 29, 2025

Department of Gastroenterology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan

Correspondence to Shuhei Hosomi, Department of Gastroenterology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahimachi, Abeno-ku, Osaka 545-8585, Japan. E-mail: shuhosomi@gmail.com

• Received: October 22, 2024 • Revised: February 12, 2025 • Accepted: February 18, 2025

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract
INTRODUCTION
METHODS
RESULTS
DISCUSSION
NOTES
Supplementary Material
REFERENCES

Abstract

Background/Aims
Pouchitis is a common complication in patients with ulcerative colitis (UC) following colectomy with ileal pouch-anal anastomosis (IPAA). Recent studies have identified a novel autoantibody against integrin αvβ6 in patients with UC, correlated with disease activity. This study aimed to assess the association between serum anti-integrin αvβ6 antibody levels and pouch inflammation in patients with postoperative UC.
Methods
Serum anti-integrin αvβ6 antibodies were measured using enzyme-linked immunosorbent assay in patients after IPAA, patients with UC, and controls.
Results
We examined sera from 71 subjects, including 28 patients who underwent IPAA, 23 controls, and 20 patients with mild and moderate-to-severe UC. Post-IPAA, patients with UC had higher median anti-integrin αvβ6 levels than that of controls (P<0.001) but lower than that of patients with active UC (P=0.001). Patients with pouchitis had higher antibody levels than those without (P=0.047). The receiver operating characteristics curve for anti-integrin αvβ6 showed an area under the curve of 0.724. The pouchitis activity index endoscopic sub-score was correlated with antibody levels (r=0.48, P=0.011).
Conclusions
Serum anti-integrin αvβ6 antibody levels remain elevated in patients with UC even after total colectomy, and were significantly higher in patients with pouchitis than in those without. This antibody could be a novel and useful biomarker for the diagnosis of pouchitis and assessment of disease activity.
Keywords: Ulcerative colitis; Pouchitis; Integrin alphavbeta6

INTRODUCTION

Ulcerative colitis (UC) is a refractory disease of unknown etiology [1], and restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the standard procedure for patients with medically refractory UC and those with familial adenomatous polyposis [2,3]. Pouchitis is the most common complication after IPAA [2,3], and is generally diagnosed by clinical, endoscopic, and histological findings, such as the Pouchitis Disease Activity Index (PDAI) and modified PDAI (mPDAI) [4,5]. Although multiple pathogenetic factors, such as bacterial overgrowth, dysbiosis, short-chain fatty acids deprivation, immune alteration, environmental factors, ischemia, oxygen radicals, and genetic susceptibility [6,7] have been suggested, the etiology of pouchitis remains unclear. Pouchitis develops in 28% to 70% of patients with UC after IPAA [8-10], but rarely occurs in patients with familial adenomatous polyposis after IPAA [11]. This suggests that immune mechanisms similar to those in UC are involved.

Recent studies have reported that anti-integrin αvβ6 antibodies occur specifically in patients with UC compared to those with Crohn’s disease and other bowel diseases, and that the severity of UC correlates with anti-integrin αvβ6 antibody levels [12-14]. Integrin αvβ6 is an extracellular transporter of fibrinogen and other cell adhesion factors that are expressed exclusively in epithelial cells [15,16]. Anti-integrin αvβ6 antibody may inhibit mucosal healing in patients with UC and may be involved in the pathogenesis of UC [12]. However, the association between elevated anti-integrin αvβ6 antibodies and disease pathology in patients with UC and whether these antibodies are a cause or a consequence of the disease remains unknown. Evaluating the serum of these patients, after total colectomy, provides a unique opportunity to study and elucidate the relationship between anti-integrin αvβ6 antibodies and UC pathology. Additionally, assessing serum anti-integrin αvβ6 antibodies in patients with pouchitis may reveal their potential as a biomarker for diagnosing pouchitis. Studies on the relationship between postoperative UC and anti-integrin αvβ6 antibodies are lacking. Thus, we aimed to clarify the significance of serum anti-integrin αvβ6 antibody levels in patients with pouchitis after IPAA and to evaluate their potential as diagnostic biomarkers for pouchitis. This study might lead to a better understanding of anti-integrin αvβ6 antibodies and their relationship to the pathophysiology of UC and pouchitis.

METHODS

This is a single-center, cross-sectional study, including retrospective data. We conducted this study in compliance with the principles of the Declaration of Helsinki. The study’s protocol was reviewed and approved by the Institutional Review Board of Osaka Metropolitan University (IRB No. 2021-269). Written informed consent was obtained from all the patients.

1. Patients

Participants who underwent lower gastrointestinal endoscopy between May 2022 and June 2023 were enrolled. The study included patients aged ≥20 years who provided written informed consent. Participants included patients with UC, post-colectomy patients with UC with an ileal pouch, and control patients without inflammatory bowel disease who underwent colonoscopy at Osaka Metropolitan University Hospital for other reasons such as treatment for colorectal polyps or colorectal cancer. All participants underwent clinical and endoscopic evaluations and serum collection within 30 days. Patients with stomas were excluded from the study. Serum samples of the study participants were obtained at the Osaka Metropolitan University Hospital, and were stored at –80 °C until assayed.

2. Measurement of Serum Anti-integrin αvβ6

The serum concentration of anti-integrin αvβ6 antibodies was measured using enzyme-linked immunosorbent assay (ELISA) kits (Code No. 5288, Anti-Integrin αvβ6 ELISA Kit; Medical & Biological Laboratories Co., Ltd, Tokyo, Japan) following the manufacturer’s instructions. ELISA samples were measured in duplicate readings for each standard, control, and sample, which were averaged.

3. Diagnosis and Definition

Pouchitis activity was assessed using mPDAI, which consists of clinical and endoscopic assessments [5]. The clinical evaluation included stool frequency, rectal bleeding, fecal urgency or abdominal cramps, and fever (0–6 points), while the endoscopic evaluation included edema, granularity, friability, loss of vascular pattern, mucous exudate, and ulceration (0–6 points). Pouchitis was diagnosed as mPDAI score ≥ 5.

4. Statistical Analysis

All statistical analyses were performed using R version 4.2.2 (The R Foundation for Statistical Computing, Vienna, Austria) and EZR version 1.61 (Saitama Medical Center, Jichi Medical University, Saitama, Japan) [17]. Continuous variables are expressed as median with 25% to 75% interquartile range (IQR). Mann-Whitney U test was performed to compare 2 groups, and the Kruskal-Wallis test was used to compare multiple groups. Categorical variables are expressed as numbers with percentages. Correlations were analyzed using Spearman’s rank correlation. The cutoff values of serum anti-integrin αvβ6 antibodies were evaluated using receiver operating characteristics and area under the curve analysis. Statistical significance was set at P<0.05.

RESULTS

1. Patient Characteristics

We evaluated serum anti-integrin αvβ6 antibodies from a total of 71 participants, including 28 patients with UC who underwent total proctocolectomy and IPAA, 20 nonoperative patients with UC, and 23 controls. The patient characteristics are summarized in Table 1. The nonoperative UC group included patients with pancolitis or left-sided colitis, exhibiting mild to severe disease activity as assessed by the Mayo score. The control group consisted of patients without inflammatory bowel disease, autoimmune diseases, collagen diseases, or malignancies. There were no significant differences in sex ratio among post-colectomy patients, UC patients, and controls; however, the control group had a significantly higher age compared to the other groups. The background characteristics of the 28 post-IPAA patients are shown in Table 2. Seventeen patients (60.7%) were male, and the median age was 51.5 years (IQR, 45.0–54.8 years). The median duration since IPAA was 14.5 years (IQR, 7.8–19.0 years). The median mPDAI score was 4.0 (IQR, 2.0–5.3), and 12 patients were diagnosed with pouchitis. Laboratory findings showed that patients with pouchitis had significantly higher levels of C-reactive protein (CRP) and significantly lower levels of hemoglobin and albumin than those without pouchitis. Patients with pouchitis were significantly more likely to be treated with systemic mesalamine than those without. None of the patients were treated with biological agents or systemic steroids. Preoperative and surgical characteristics of post-IPAA patients are summarized in Supplementary Table 1.

2. Comparison of Serum Anti-integrin αvβ6 Levels between the 3 Groups

Fig. 1 shows the comparison of serum anti-integrin αvβ6 levels between post-colectomy, active UC, and controls. The median values of serum anti-integrin αvβ6 antibodies in post-colectomy patients, those with active UC, and controls were 758 U/mL (IQR, 354–1,679 U/mL), 3,464 U/mL (IQR, 1,007–6,264 U/mL), and 43 U/mL (IQR, 35–63 U/mL), respectively, which indicates significant differences between the 3 groups (P<0.001). The median serum anti-integrin αvβ6 antibody levels in post-colectomy patients were significantly lower than those in patients with active UC (P=0.001) and significantly higher than those in controls (P<0.001).

3. Anti-integrin αvβ6 in Patients with Pouchitis

The median levels of anti-integrin αvβ6 antibodies were significantly higher in patients with pouchitis than in those without (1,431 U/mL [IQR, 393–3,304 U/mL] vs. 520 U/mL [IQR, 156–996 U/mL], P=0.047) (Fig. 2A). Fig. 2B illustrates the receiver operating characteristics curve showing the diagnostic performance of serum anti-integrin αvβ6 antibodies for pouchitis. The area under the curve was 0.724 (95% CI, 0.524–0.924). There was no significant correlation between the antibody levels and the duration since IPAA in the overall post-colectomy patients (r =–0.061, P=0.757) or in patients with pouchitis (r =0.389, P=0.212). However, in patients without pouchitis, a significant negative correlation was observed (r=–0.536, P=0.032) (Supplementary Fig. 1). Fig. 3 shows the correlation between the mPDAI scores and serum anti-integrin αvβ6 antibody levels. Although there was no significant correlation between mPDAI (Fig. 3A) and anti-integrin αvβ6 antibody levels, or between PDAI clinical sub-score and the antibody levels (Fig. 3B), PDAI endoscopic sub-score was moderately correlated with the levels of serum anti-integrin αvβ6 antibodies (r =0.48, P=0.011) (Fig. 3C). Anti-αvβ6 antibody levels did not correlate with other biomarkers, such as CRP and albumin, which showed significant differences in patients with pouchitis (r=0.084, P=0.795 in CRP and r=0.011, P=0.974 in albumin).

DISCUSSION

In this study, we demonstrated that serum anti-integrin αvβ6 antibody levels remain elevated in patients with UC even after total colectomy. Furthermore, within the group of post-colectomy patients, those who developed pouchitis exhibited particularly high levels of serum anti-integrin αvβ6 antibody.

Autoimmune mechanisms have long been believed to be involved in the pathophysiology of UC [18,19] and Kuwada et al. [12] showed that anti-integrin αvβ6 antibody levels were elevated in patients with UC. This suggests that integrin αvβ6 on colonic epithelial cells is an autoantigen in UC, and that antibodies in patients with UC inhibit the binding between integrin αvβ6 and fibronectin, potentially playing a central role in the pathogenesis of UC. However, whether these autoantibodies have a pathogenic role or their production is a secondary event following epithelial cell destruction in UC remains unknown.

In this study, we demonstrated that antibody levels were higher in patients even ≥10 years after surgery than that in healthy controls. It is known that integrin αvβ6 is expressed in epithelial cells throughout the body [20] and is an important molecule in the maintenance of the intestinal barrier function [21], including the small intestinal epithelial cells [22]. The fact that serum antibody levels were elevated even in patients long after total colectomy may suggest that the antibodies are involved in the pathogenesis of UC and are targeting integrin αvβ6 in tissues other than colonic epithelial cells. In patients without pouchitis, antibody levels decreased with longer duration since IPAA. In contrast, in patients with pouchitis, there was no correlation between duration since IPAA and antibody levels, which were significantly higher than in patients without pouchitis. This suggests that, whereas the production of antibodies would be reduced by the removal of the entire colon with increased integrin αvβ6 expression due to inflammation, which serves as the primary site of inflammation, autoantibodies against integrin αvβ6 are persistently produced and inhibit integrin αvβ6-fibronectin binding in the ileal pouch epithelial cells, resulting in mucosal injury similar to that seen in UC.

Our study also showed that the endoscopic activity of pouchitis positively correlated with antibody levels. Despite a moderate correlation between the endoscopic sub-score and antibody levels, there was no correlation between clinical symptoms and antibody levels potentially because of a lack of correlation between the clinical and endoscopic findings in mPDAI. For example, some patients had no or mild symptoms with a clinical score ≤2, but had a high endoscopic sub-score. The factors that comprise PDAI are independent of each other and lack a correlation between the component scores [23]. Pouchitis cannot be diagnosed and disease activity cannot be assessed based on symptoms alone, making pouchoscopy essential for endoscopic and histological evaluation. However, there is a need for less invasive methods. This study indicates that serum anti-integrin αvβ6 antibody levels may reflect ileal pouch inflammation, suggesting that the antibody could be a non-invasive approach to evaluate ileal pouch inflammation, potentially replacing the need for pouchoscopy.

This study had some limitations. This was a single-center cross-sectional study with a small number of patients and retrospective data. Thus, it was susceptible to bias in data selection and analysis. This study included only patients who regularly attended our hospital and underwent endoscopic examinations or were hospitalized for treatment. Therefore, patients without symptoms or endoscopic inflammation may have been excluded. In addition, we did not perform pathological and immunohistological assessment of anti-αvβ6 antibody expression in the pouch. We did not compare anti-integrin αvβ6 antibodies to other biomarkers reported to be associated with pouchitis, such as fecal calprotectin or neutrophil-to-lymphocyte ratio [24-26]. Furthermore, the onset of pouchitis is reportedly influenced by the condition of UC before total colectomy, including factors such as disease type [27], the dosage of steroids [28], and the use of tumor necrosis factor-α inhibitors [29]. Nevertheless, in the present study, we were unable to evaluate the influence of preoperative conditions due to the inaccessibility of some patients’ medical records, as their surgeries had been performed at other hospitals or in the distant past. Furthermore, due to the limited number of patients who underwent mucosectomy, we were unable to adequately evaluate the impact of the presence or absence of residual rectal mucosa on antibody levels. Additionally, we performed endoscopic evaluations and antibody titer measurements at only 1 time point. A previous study reported that anti-integrin αvβ6 antibody is associated with disease prognosis and could be a preclinical biomarker in patients with UC [30]. However, we could not prove whether the antibody levels are associated with the clinical course and response to treatment, or if they can predict the onset of pouchitis. Further prospective cohort studies are required to test these hypotheses.

In conclusion, we found that serum anti-integrin αvβ6 antibody levels remain elevated in patients with UC even after total colectomy. Additionally, we showed that serum anti-integrin αvβ6 antibody levels are elevated in those with pouchitis among patients with UC even after total colectomy, suggesting that this antibody could be a novel and useful biomarker for the diagnosis of pouchitis and assessing disease activity.

NOTES

Funding Source

The authors received no financial support for the research, authorship, and/or publication of this article.

Conflict of Interest

No potential conflict of interest relevant to this article was reported.

Data Availability Statement

The data that support the findings of this study are available on reasonable request from the corresponding author.

Author Contributions

Conceptualization: Yanagida T, Nishida Y, Hosomi S. Data curation: Yanagida T, Nishida Y, Kobayashi Y, Nakata R, Hosomi S, Maruyama H, Ominami M, Nadatani Y, Fukunaga S, Otani K. Tanaka F, Fujiwara Y. Formal analysis: Yanagida T, Nishida Y, Hosomi S. Investigation: Yanagida T, Nishida Y, Hosomi S. Methodology: Yanagida T, Nishida Y, Hosomi S. Project administration: Hosomi S, Fujiwara Y. Resources: Nishida Y, Kobayashi Y, Nakata R, Hosomi S, Maruyama H, Ominami M, Fukunaga S, Otani K. Tanaka F, Fujiwara Y. Supervision: Hosomi S, Fujiwara Y. Visualization: Yanagida T, Nishida Y, Hosomi S. Writing - original draft: Yanagida T, Nishida Y, Hosomi S. Writing - review & editing: all authors. Approval of final manuscript: all authors.

Supplementary Material

Supplementary materials are available at the Intestinal Research website (https://www.irjournal.org).

Supplementary Table 1.

Preoperative and Surgical Information for Post-colectomy Patients

ir-2024-00170-Supplementary-Table-1.pdf

Supplementary Fig. 1.

Correlation between serum anti-integrin αvβ6 levels and the duration since IPAA. (A) There was no significant correlation between the antibody levels and the duration since IPAA in patients with pouchitis (r=0.389, P=0.212). (B) In patients without pouchitis, a significant negative correlation was observed (r=–0.536, P=0.032). IPAA, ileal pouch-anal anastomosis.

ir-2024-00170-Supplementary-Fig-1.pdf

Fig. 1.

Comparison of serum anti-integrin αvβ6 levels in post-colectomy patients with UC. The serum anti-integrin αvβ6 levels in post-colectomy patients with UC were compared to those in active UC patients and in controls. There were significant differences between the 3 groups (P<0.001). UC, ulcerative colitis.

Fig. 2.

Comparison of serum anti-integrin αvβ6 levels in patients with and without pouchitis. (A) Comparison of anti-integrin αvβ6 levels in patients with and without pouchitis. (B) ROC curve for anti-integrin αvβ6 in diagnosing pouchitis (AUC, 0.72). The highest combined sensitivity (50.0%) and specificity (93.8%) occurred at the anti-integrin αvβ6 cutoff level of 1,846 U/mL. ^aP<0.05 using Mann-Whitney U test. ROC, receiver operating characteristics; AUC, area under the curve.

Fig. 3.

Correlation between serum anti-integrin αvβ6 levels and disease activity of pouchitis. There was no correlation between serum anti-integrin αvβ6 levels and the mPDAI (r=0.36, P=0.06) (A), and between antibody levels and the PDAI clinical sub-score (r=–0.18, P=0.35) (B). There was a positive correlation between antibody levels and the PDAI endoscopic sub-score (r=0.48, P=0.01) (C). PDAI, Pouchitis Activity Index; mPDAI, modified PDAI.

Table 1.

Characteristics of Participants

Characteristic	Post-colectomy (n = 28)	Active UC (n = 20)	Control (n = 23)
Sex
Male	17 (60.7)	12 (60.0)	14 (60.9)
Female	11 (39.3)	8 (40.0)	9 (39.1)
Age (yr)	51.5 (45.0–54.8)	41.0 (30.0–58.3)	77.0 (61.5–81.5)
Duration since IPAA (yr)	14.5 (7.8–19.0)	NA	NA
CRP (mg/L)	0.55 (0.20–2.00)	5.75 (3.05–27.53)	0.70 (0.30–1.70)
WBC (× 10⁹/L)	6.15 (5.38–7.18)	6.90 (5.55–9.88)	5.40 (4.60–6.55)
Hemoglobin (g/dL)	13.8 (12.3–14.9)	13.0 (11.7–14.1)	12.9 (12.3–14.2)
Albumin (g/dL)	4.25 (4.00–4.40)	3.70 (3.18–4.20)	3.90 (3.65–4.40)

Values are presented as number (%) or median (interquartile range).

UC, ulcerative colitis; IPAA, ileal pouch-anal anatomosis; CRP, C-reactive protein; WBC, white blood cell; NA, not available.

Table 2.

Comparision of Post-colectomy Patients’ Characteristics with and without Pouchitis

Characteristic	Patients without pouchitis (n = 16)	Patients with pouchitis (n = 12)	P-value
Sex
Male	9 (56.2)	8 (66.7)	0.71
Female	7 (43.8)	4 (33.3)
Age (yr)	52.0 (46.8–58.8)	47.0 (43.0–52.50)	0.16
Duration since IPAA (yr)	16.0 (11.5–18.3)	13.0 (7.8–19.5)	0.80
CRP (mg/L)	0.35 (0.1–2.6)	1.7 (0.10–34.2)	0.04
WBC (× 10⁹/L)	5.95 (5.38–7.28)	6.15 (5.53–6.58)	0.87
Hemoglobin (g/dL)	14.4 (13.6–15.0)	12.6 (11.2–14.0)	0.04
Albumin (g/dL)	4.30 (4.10–4.40)	3.85 (3.55–4.35)	0.04
mPDAI	2.0 (2.0–4.0)	6.0 (5.0–7.5)	0.04
Mediations
Antibiotics	2 (12.5)	3 (25.0)	0.62
Mesalazine local	3 (18.8)	5 (41.7)	0.23
Mesalazine systemic	2 (12.5)	7 (58.3)	0.02
Steroid local	0	1 (8.3)	0.43

Values are presented as number (%) or median (interquartile range).

IPAA, ileal pouch-anal anastomosis; CRP, C-reactive protein; WBC, white blood cell; mPDAI, modified Pouchitis Disease Activity Index.

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Anti-integrin αvβ6 autoantibody in patients with ulcerative colitis after proctocolectomy: a cross-sectional study in Japan

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Anti-integrin αvβ6 autoantibody in patients with ulcerative colitis after proctocolectomy: a cross-sectional study in Japan

Fig. 1. Comparison of serum anti-integrin αvβ6 levels in post-colectomy patients with UC. The serum anti-integrin αvβ6 levels in post-colectomy patients with UC were compared to those in active UC patients and in controls. There were significant differences between the 3 groups (P<0.001). UC, ulcerative colitis.

Fig. 2. Comparison of serum anti-integrin αvβ6 levels in patients with and without pouchitis. (A) Comparison of anti-integrin αvβ6 levels in patients with and without pouchitis. (B) ROC curve for anti-integrin αvβ6 in diagnosing pouchitis (AUC, 0.72). The highest combined sensitivity (50.0%) and specificity (93.8%) occurred at the anti-integrin αvβ6 cutoff level of 1,846 U/mL. aP<0.05 using Mann-Whitney U test. ROC, receiver operating characteristics; AUC, area under the curve.

Fig. 3. Correlation between serum anti-integrin αvβ6 levels and disease activity of pouchitis. There was no correlation between serum anti-integrin αvβ6 levels and the mPDAI (r=0.36, P=0.06) (A), and between antibody levels and the PDAI clinical sub-score (r=–0.18, P=0.35) (B). There was a positive correlation between antibody levels and the PDAI endoscopic sub-score (r=0.48, P=0.01) (C). PDAI, Pouchitis Activity Index; mPDAI, modified PDAI.

Fig. 1.

Fig. 2.

Fig. 3.

Anti-integrin αvβ6 autoantibody in patients with ulcerative colitis after proctocolectomy: a cross-sectional study in Japan

Characteristic	Post-colectomy (n = 28)	Active UC (n = 20)	Control (n = 23)
Sex
Male	17 (60.7)	12 (60.0)	14 (60.9)
Female	11 (39.3)	8 (40.0)	9 (39.1)
Age (yr)	51.5 (45.0–54.8)	41.0 (30.0–58.3)	77.0 (61.5–81.5)
Duration since IPAA (yr)	14.5 (7.8–19.0)	NA	NA
CRP (mg/L)	0.55 (0.20–2.00)	5.75 (3.05–27.53)	0.70 (0.30–1.70)
WBC (× 10⁹/L)	6.15 (5.38–7.18)	6.90 (5.55–9.88)	5.40 (4.60–6.55)
Hemoglobin (g/dL)	13.8 (12.3–14.9)	13.0 (11.7–14.1)	12.9 (12.3–14.2)
Albumin (g/dL)	4.25 (4.00–4.40)	3.70 (3.18–4.20)	3.90 (3.65–4.40)

Characteristic	Patients without pouchitis (n = 16)	Patients with pouchitis (n = 12)	P-value
Sex
Male	9 (56.2)	8 (66.7)	0.71
Female	7 (43.8)	4 (33.3)
Age (yr)	52.0 (46.8–58.8)	47.0 (43.0–52.50)	0.16
Duration since IPAA (yr)	16.0 (11.5–18.3)	13.0 (7.8–19.5)	0.80
CRP (mg/L)	0.35 (0.1–2.6)	1.7 (0.10–34.2)	0.04
WBC (× 10⁹/L)	5.95 (5.38–7.28)	6.15 (5.53–6.58)	0.87
Hemoglobin (g/dL)	14.4 (13.6–15.0)	12.6 (11.2–14.0)	0.04
Albumin (g/dL)	4.30 (4.10–4.40)	3.85 (3.55–4.35)	0.04
mPDAI	2.0 (2.0–4.0)	6.0 (5.0–7.5)	0.04
Mediations
Antibiotics	2 (12.5)	3 (25.0)	0.62
Mesalazine local	3 (18.8)	5 (41.7)	0.23
Mesalazine systemic	2 (12.5)	7 (58.3)	0.02
Steroid local	0	1 (8.3)	0.43

Table 1. Characteristics of Participants

Values are presented as number (%) or median (interquartile range).

UC, ulcerative colitis; IPAA, ileal pouch-anal anatomosis; CRP, C-reactive protein; WBC, white blood cell; NA, not available.

Table 2. Comparision of Post-colectomy Patients’ Characteristics with and without Pouchitis

Values are presented as number (%) or median (interquartile range).

IPAA, ileal pouch-anal anastomosis; CRP, C-reactive protein; WBC, white blood cell; mPDAI, modified Pouchitis Disease Activity Index.