The Diagnostic Accuracy of Serologic Markers in Children With IBD

Elitsur, Yoram; Lawrence, Zandra; Tolaymat, Naser

doi:10.1097/01.mcg.0000173853.78042.2d

Cited by 25 publications

(10 citation statements)

References 17 publications

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“…A fact which may itself reflect a distinct clinicoserological entity is that 48.5% of patients do not show antibodies against either ASCA or pANCA 98 . Whilst some subsequent studies have cast doubts over the usefulness of these markers, many have concurred with the original findings 99–103 …”

Section: Ic Ancillary Tests and The Futurementioning

confidence: 97%

“…98 Whilst some subsequent studies have cast doubts over the usefulness of these markers, many have concurred with the original findings. [99][100][101][102][103] Molecular studies amplifying Yersinia DNA from CD resection specimens have shown up to 31% positivity. However, further studies are needed to determine whether the presence of Yersinia DNA is an epiphenomenon or a feature of CD pathogenesis.…”

Section: Serological Markersmentioning

confidence: 99%

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Indeterminate colitis: definition, diagnosis, implications and a plea for nosological sanity

Martland¹,

Shepherd²

2006

Histopathology

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In 1978, Price introduced the concept of indeterminate colitis to describe cases in which colonic resections had been undertaken for chronic inflammatory bowel disease (CIBD), but a definitive diagnosis of either of the classical types of CIBD, ulcerative colitis and Crohn's disease, was not possible. This was especially apposite in cases of acute fulminant disease of the colorectum. More recently, the term indeterminate colitis has been applied to biopsy material, when it has not been possible to differentiate between ulcerative colitis and Crohn's disease. In our opinion, and in those of other workers in this field, the term should be restricted to that originally suggested by Price. This then provides a relatively well-defined group of patients in whom the implications and management of the disease are becoming much clearer. Cases where there are only biopsies with CIBD, but equivocal features for ulcerative colitis and Crohn's disease, should be termed 'CIBD, unclassified', 'equivocal/non-specific CIBD' or IBD unclassified (IBDU), in line with recent recommendations. When the diagnosis is correctly restricted to colectomy specimens, there is now good evidence that the majority of cases will behave like ulcerative colitis. Furthermore, the diagnosis should not be a contraindication to subsequent pouch surgery. When the latter is undertaken, surgeons and patients can expect an increased complication rate, compared with classical ulcerative colitis, especially of pelvic sepsis, but most patients fare well. Only very occasional patients, around 10%, will eventually be shown to have Crohn's disease. This review describes the pathology of cases appropriately classified as indeterminate colitis and the implications of that diagnosis. It also highlights recent advances in its pathological features, clinical management and its immunological and genetic associations.

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Section: Ic Ancillary Tests and The Futurementioning

confidence: 97%

Section: Serological Markersmentioning

confidence: 99%

Indeterminate colitis: definition, diagnosis, implications and a plea for nosological sanity

Martland¹,

Shepherd²

2006

Histopathology

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“…Things may be different in children with IBD, where these tests could be clinically useful to differentiate between IBD and other diarrheal illnesses [1, 5]. Actually, many [6,7,8,9,10,11,12,13,14,15] but not all [16] available studies in IBD pediatric populations reported that testing for these antibodies yields significantly useful clinical information and may avoid further unnecessary examinations.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Value of Serological Assays in Pediatric Inflammatory Bowel Disorders

Mainardi

Villanacci²,

Bassotti

et al. 2007

Digestion

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Background: Pediatric studies reported that the combined use of the anti-neutrophil cytoplasm autoantibodies (ANCA) and the anti-Saccharomyces cerevisiae mannan antibodies (ASCA) may be a specific useful noninvasive test in the diagnosis of inflammatory bowel diseases (IBD). Aims: To evaluate the diagnostic accuracy of ANCA and ASCA in children with suspected IBD, and to see whether different commercially available assays (indirect immunofluorescence vs. ELISA) agree well enough in terms of analytical performance. Patients and Methods: Sixty-nine children (30 males, 39 females, age range 2–18 years) with suspicion of IBD entered the study. Before colonoscopy, a blood sample was also drawn to assess ASCA and ANCA. Results: A diagnosis of IBD was established in 47 patients; the remainder had infective or other causes of colitis. For ulcerative colitis, the association ASCA–/ANCA+ had 70% sensitivity and 86% specificity, with a positive predictive value of 82%. The association ASCA+/ANCA– had 86% sensitivity and 93% specificity for Crohn’s disease, with a positive predictive value of 75%. Conclusion: Although more experience is needed to state the diagnostic power of serologic assay, determination of ANCA and ASCA in IBD children may help both in distinguish these conditions from other entitiesand ulcerative colitis from Crohn’s disease, particularly in doubtful cases.

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“…Thus far, independent studies have reported poor sensitivity for OmpC IgA in IBD, and false positives are common (6,43).…”

mentioning

confidence: 99%

Analysis of Serum Antibodies in Patients Suspected of Having Inflammatory Bowel Disease

Jaskowski

Litwin

Hill

2006

Clin Vaccine Immunol

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Inflammatory bowel disease (IBD) is the general term used for a heterogeneous group of intestinal disorders, including Crohn's disease (CD) and ulcerative colitis (UC). Serological markers such as anti-Saccharomyces cerevisiae antibodies (ASCA) and atypical perinuclear antineutrophilic cytoplasmic antibody (atypical pANCA) have proven useful in the diagnosis and differentiation of CD and UC. Immunoglobulin A (IgA) antibody directed against the outer membrane protein C (OmpC) of Escherichia coli is said by one group to have clinical utility in diagnosing IBD, specifically in ASCA-negative CD patients. Our objective in this study was to compare the results obtained from two separate laboratories offering similar IBD tests using sera from suspected IBD patients. One hundred ninety-seven sera received for IBD testing were included in the study. The agreement between the two laboratories was 93.4% for ASCA IgA, 90.9% for ASCA IgG, and 87.8% for atypical pANCA IgG. There were 25 sera with ASCA-negative/OmpC-positive results reported by one laboratory. Thirteen of these 25 (52.0%) ASCA-negative/OmpC-positive sera were also atypical pANCA positive (9 as determined by both laboratories, 3 by one, and 1 by the other). Atypical pANCA antibody is found primarily in IBD patients with UC and colon-limited CD (Crohn's colitis). We conclude that the ASCA and atypical pANCA assays showed good agreement between the two laboratories, but the data for ASCA-negative/OmpCpositive sera suggest that many (52.0%) of these patients were more likely to have had UC or Crohn's colitis based on the presence of an atypical pANCA.Crohn's disease (CD) and ulcerative colitis (UC) are the two major forms of inflammatory bowel disease (IBD). Both CD and UC are chronic, affecting children and adults (men and women almost equally), and are most common in northern Europe and North America. The onset of CD and UC is usually between the ages of 15 and 30, with a second, smaller peak of incidence between the ages of 50 and 70 (4, 23). Approximately 20% of individuals with CD have a biological relative with some form of IBD, and several reports have noted an increase in the prevalence of CD and UC in various geographic regions (2,17,24,36).Although there are many theories about the etiology of CD and UC, none have been proven. Many of the symptoms of CD and UC are similar, and diagnosis is often difficult, time-consuming, and invasive. Since CD and UC are treated differently, correct diagnosis and differentiation are medically important.Two serological markers have been found to have clinical utility in diagnosing IBD and aiding in the differentiation of CD from UC: anti-Saccharomyces cerevisiae antibody (ASCA) (immunoglobulin A [IgA] and/or IgG), using enzyme immunoassay (EIA) techniques, and antineutrophil cytoplasmic antibody (ANCA) (IgG) that demonstrates atypical perinuclear staining (pANCA), using indirect fluorescent-antibody assay (IFA) techniques. ASCA is directed against mannose sequences in the cell wall of Saccharomyces cerevisiae (26,35) and...

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The Diagnostic Accuracy of Serologic Markers in Children With IBD

Abstract: Despite our homogeneous patient population, pANCA and ASCA antibodies had an inadequate sensitivity/specificity for children with UC or CD. Those antibodies were not useful for our small number of patients with IC.

Cited by 25 publications

References 17 publications

Indeterminate colitis: definition, diagnosis, implications and a plea for nosological sanity

Indeterminate colitis: definition, diagnosis, implications and a plea for nosological sanity

Diagnostic Value of Serological Assays in Pediatric Inflammatory Bowel Disorders

Analysis of Serum Antibodies in Patients Suspected of Having Inflammatory Bowel Disease

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