The Prevalence and Clinical Significance of Perinuclear Anti-neutrophil Cytoplasmic Antibody in Korean Patients with Ulcerative Colitis

Abstract

Perinuclear anti-neutrophil cytoplasmic antibody (pANCA) is a serological marker associated with various immune-mediated diseases whose clinical significance and possible diagnostic roles in ulcerative colitis (UC) are still unclear. We aimed to evaluate the prevalence of pANCA expression and its association with clinical findings and disease course in Korean patients with UC. This study included 484 patients with UC who were diagnosed and treated between 1990 and 2006 at Severance Hospital, Yonsei University, Seoul, Korea, and were followed for at least 1 year. Clinical findings at diagnosis, disease extent, treatment modalities used, and cumulative relapse rates were analyzed and compared to pANCA expression. Of the 484 patients, 405 (83.7%) were evaluated for pANCA and were eligible for analysis. The overall pANCA prevalence was 22.1%, with a female preponderance (male, 21.5%; female, 31.6%; P < 0.05). Proctitis was more common in pANCA-negative patients (pANCA-negative, 37.6%; pANCA-positive, 25.2%, P < 0.05). UC activity index and cumulative relapse rates were higher in pANCA-positive patients. However, there were no significant differences in the cumulative probability of steroid and immunosuppressant use and operation rate between the two groups. The prevalence of pANCA expression in Korean patients with UC was relatively low compared to that in Western countries. Although UC patients with pANCA expression had more severe clinical findings at diagnosis and higher cumulative relapse rates in our study, further prospective studies are warranted to clarify whether pANCA positivity influences the initial clinical presentation or disease aggressiveness.

Serological Antibodies in Inflammatory Bowel Disease: A Systematic Review

“…The prevalence of pANCA in Japanese,148 Korean,149 Thai,150 and Romanian151 patients with UC is lower compared with Caucasians, but comparable to Caucasian data in Mexico,152 Estonia,153 and a different Korean cohort 142. pANCA was found more frequently in UC patients with more extensive disease in China147 and Korea,149 with relapse rates higher when pANCA was present in the Korean cohort 149…”

Inflammatory Bowel Disease in Korea: Epidemiological, Genomic, Clinical, and Therapeutic Characteristics

“…146,147 In contrast, studies from Korea reveal that it is 2.0-3.0% after one year and 3.3% after five to 15 years. 17,20 Furthermore, the author showed that there were no deaths associated with UC in that study, suggesting that Korean UC patients tend to have a milder form of the disease.…”

“…A surgical approach is required for treatment of UC when there are life-threatening complications such as 20 • The cumulative colectomy rate is much lower in Korean UC patients than that in Western patients 17,20 • The rate of pouchitis after IPAA in Korean UC patients was similar to that in Western patients (37.5% vs 24-48%) 141 hemorrhage or perforation, and documented dysplasia or cancer. Other indications for surgery include fulminant colitis with or without toxic megacolon refractory to maximal medical management or intolerance to immunosuppression or medical therapy.…”

“…While there are several diagnostic criteria available for IBD including Mendeloff's criteria, 37 Lennard-Jones criteria, 38 42 However, in a recent Korean study, Lee et al reported that the prevalence of pANCA in Korean patients with UC was relatively low compared to patients in Western countries (22% vs 59-84%). 17 The major distinctive clinical, morphological, structural and pathological features between the two subforms of IBD are listed in Table 2. As genome-wide association studies have been introduced in an effort to identify the etiologic factors of IBD, many genetic polymorphisms related to an increased risk of IBD have been discovered.…”

“…1,9 This review will describe the updated data on Korean IBD patients based on the recent publications. 1,8,[11][12][13][14][15][16][17][18][19][20] …”