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Abstract：
Following restorative proctocolectomy with an ileal pouch-anal anastomosis, the small bowel mucosa undergoes several specific histologic adaptions, which may be unrelated to the underlying disease or symptoms of pouchitis. An increase in intraepithelial lymphocytes (IELs) has not been described as part of this spectrum. Mucosal biopsies of the ileal pouch and afferent limb of 230 patients (mean age: 45.7y [18.3-74.7], gender [female/male]: 117/113) with a functioning ileal pouch-anal anastomosis (mean time since ileostomy closure: 10.8months) and associated clinically annotated outcome data were assessed for IELs/100 enterocytes. Forty-two patients (18.3%) showed an increase in IELs (≥20 IELs/100 enterocytes [range 20-39]), in pouch and/or afferent limb biopsies. Intraepithelial lymphocytosis was more commonly observed in afferent limb compared to pouch biopsies (18.8% vs 8.3%; P = .42) and in familial adenomatous polyposis compared to ulcerative colitis patients (16% vs 8%; P = 0.36), but neither difference reached statistical significance. No cases with increased IELs displayed severe villous blunting. Increased IELs were not significantly associated with age, sex, ethnicity, smoking history, time since ileostomy, use of antibiotics, biologic agents, anti-diarrheal agents or probiotics, C-reactive protein levels or differential white cell count. None of the 42 patients with increased IELs had positive celiac serology (anti-human tissue transglutaminase IgA [ELISA] with corresponding total serum IgA). Intraepithelial lymphocytosis in pouch biopsies may represent a subclinical response to an altered bacterial microenvironment. Pathologists should be aware that intraepithelial lymphocytosis is part of the spectrum of changes in pouch biopsies, and only rarely is due to celiac disease.
摘要：
回肠袋-肛门吻合术的恢复性直肠结肠切除术后，小肠粘膜经历了几种特定的组织学适应，可能与潜在疾病或囊炎症状无关。尚未将上皮内淋巴细胞（IEL）的增加描述为该光谱的一部分。230例患者的回肠袋和传入肢体的粘膜活检（平均年龄：45.7y[18.3-74.7]，性别[女性/男性]:117/113)具有功能性回肠袋-肛门吻合术(回肠造口术闭合后的平均时间:10.8个月),并对IELs/100肠细胞的相关临床注释结果数据进行了评估.42例患者（18.3%）显示IEL增加（≥20IEL/100肠细胞[范围20-39]），在袋和/或传入肢体活检中。与囊袋活检相比，上皮内淋巴细胞增多在传入肢体中更为常见（18.8％vs8.3％；P=.42），与溃疡性结肠炎患者相比，家族性腺瘤性息肉病（16％vs8％；P=0.36），但差异均无统计学意义。IEL增加的病例没有表现出严重的绒毛钝化。IEL的增加与年龄无关，性别,种族,吸烟史,回肠造口术以来的时间，使用抗生素，生物制剂，止泻药或益生菌，C反应蛋白水平或差异白细胞计数。IEL升高的42例患者均无乳糜泻血清学阳性（抗人组织转谷氨酰胺酶IgA[ELISA]和相应的总血清IgA）。囊袋活检中的上皮内淋巴细胞增多可能代表对细菌微环境改变的亚临床反应。病理学家应该意识到，上皮内淋巴细胞增多是囊袋活检变化谱的一部分，很少是由于乳糜泻。
