The impact of intestinal resection on serum levels of anti‐Saccharomyces cerevisiae antibodies (ASCA) in patients with Crohn’s disease

Abstract

SUMMARY BackgroundAntibodies to Saccharomyces cerevisiae (ASCA) are highly prevalent in sera of patients with Crohn's disease and have been proposed to identify subgroups of patients with a disabling disease course.

The clinical significance of antimicrobial serologic responses within an Irish Crohn’s disease population

“…ASCA positivity was shown to precede symptoms of CD in a cohort of Israeli soldiers who had had serum stored at the time of enlistment to the army and later developed CD [31]. Studies have shown no significant changes in ASCA, anti-OmpC, anti-I2 or ANCA more than 6 months following small bowel surgery [26,32] or following induction of remission with infliximab in those with documented mucosal healing [3]. Further longitudinal studies assessing alterations in serological responses and disease progression are needed, however.…”

Recommendations for identifying Crohn’s disease patients with poor prognosis

“…Interestingly, serum ASCA levels remain stable after curative intestinal resection in CD [75], indicating the persistence of both the stimulus and immunological mechanisms operative in the production of ASCA even after complete surgical resection of macroscopically inflamed intestinal tissue, or alternatively indicating that longer time is needed for the loss of antibody response as suggested by the data from the celiac literature [76]. Similarly in a study by Rieder et al, it was observed that a variation in titer, but not marker positivity, was reported for antiglycan antibodies in medically or surgically induced remission [77].…”

Circulating Antibodies against Bacterial Wall Products: Are There Arguments for Early Immunosuppression?

“…Eser et al [115] reported stable ASCA levels before and after intestinal resection. No significant changes in serological responses toward ASCA, anti-I2 and Omp-C after small-bowel surgery with or without fecal diversion were found [84,86,121].…”

“…Eser et al [115] examined a possible link between preoperative ASCA levels and the risk of surgical recurrence. After intestinal resection, neither ASCA positivity nor ASCA serum levels predicted the risk of surgical recurrence during long-term follow-up (median of 106 months).…”

“…Most publications only use one single sample per patient to determine stability, but this cross-sectional design makes claims about stability and potential influential factors difficult [37,60,81,86,87,95,121,124]. Data about level or status changes of serum markers over time in individual patients [81,86,87,95,115,124] are indeed available in a few studies; all of these have either low patient numbers or a short follow-up time, however. …”