Shen et al developed a Cuffitis Activity Index (CAI) to describe rectal cuff inflammation in a patient with ulcerative colitis following restorative proctocolectomy and ileal pouch-anal anastomosis. This is based on the Pouchitis Disease Activity Index (above) and can be used to monitor the effectiveness of anti-inflammatory therapy. The authors are from the Cleveland Clinic.
Following an ileoanal anastomosis there is a 1 to 2 cm length ("cuff") of rectal and anal tissue that is subject to inflammation ("cuffitis") and eventually dysplasia.
Clinical findings include:
(1) abdominal pain
(2) bloody bowel movements
(3) diarrhea
(4) perianal pain
(5) urgency
(6) arthralgias and other extraintestinal manifestations
Parameters:
(1) stool frequency
(2) rectal bleeding
(3) fecal urgency and/or abdominal cramping
(4) fever
(5) endoscopic features (6, see below)
(6) histologic features in the anal cuff (2, see below)
|
Parameter |
Finding |
Points |
|
stool frequency |
usual postoperative frequency |
0 |
|
|
1 to 2 stools per day in excess of usual postoperative frequency |
1 |
|
|
3 or more stools per day in excess of usual postoperative frequency |
2 |
|
rectal bleeding |
none |
0 |
|
|
rare |
0 |
|
|
present daily |
1 |
|
urgency, abdominal cramping |
none |
0 |
|
|
occasional |
1 |
|
|
usual |
2 |
|
fever (temperature > 100.5°F) |
absent |
0 |
|
|
present |
1 |
|
Endoscopic Parameter |
Finding |
Points |
|
edema |
absent |
0 |
|
|
present |
1 |
|
granularity |
absent |
0 |
|
|
present |
1 |
|
friability |
absent |
0 |
|
|
present |
1 |
|
loss of vascular pattern |
absent |
0 |
|
|
present |
1 |
|
mucus exudates |
absent |
0 |
|
|
present |
1 |
|
ulceration |
absent |
0 |
|
|
present |
1 |
|
Histologic Parameter |
Finding |
Points |
|
polymorph infiltration |
none |
0 |
|
|
mild |
1 |
|
|
moderate with crypt abscesses |
2 |
|
|
severe with crypt abscesses |
3 |
|
ulceration per low power field |
none |
0 |
|
|
1 - 24% |
1 |
|
|
25 - 50% |
2 |
|
|
51 - 100% |
3 |
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 18
• A score >= 7 indicates cuffitis is present.
Specialty: Gastroenterology
