Comparison of the Moskowitz criteria and the pouchitis disease activity index (PDAI) for diagnosis of ileoanal pouch inflammation

Objective. To prospectively compare two indices for diagnosis of pouchitis: Moskowitz criteria and pouchitis disease activity index (PDAI). Patients and methods. Fifty-six consecutive patients with an ileoanal pouch for ulcerative colitis were recruited. A clinical questionnaire was composed and the Öresland functional score calculated. Pouchoscopy and biopsy were performed after cleansing of the pouch. Results. Seven patients had pouchitis according to both Moskowitz and PDAI ('positive' group). Five patients had PDAI ≥ 7, but did not fulfil the Moskowitz criteria ('negative' group). The pouchoscopy and Öresland functional scores were similar between the two groups. The biopsy neutrophilia and ulceration were more prominent in the 'positive' group (χ² = 5.18, P < 0.05), whereas urgency (χ² = 8.4, P < 0.001), evacuation difficulties (χ² = 5.18, P < 0.05) and history of bleeding per pouch (χ² = 4.18, P < 0.05) were more pronounced in the 'negative' group. Conclusion. Moskowitz criteria may be broadly in agreement with the PDAI; these, however, cannot be regarded as interchangeable.