Walker, L.; Aldhous, M.C.; Satsangi, J.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA68
Academic Journal
Background: Crohn's disease (CD) and ulcerative colitis (UC) can be difficult to differentiate clinically. Anti-Saccharomyces cerevisiae antibodies (ASCAs) have been proposed as diagnostic tools for CD. Mutations in the NOD2 gene engender susceptibility to CD but not UC. We investigated the possible relationship between NOD2 mutations, disease phenotype and ASCAs in CD, and whether ASCAs were related to antibodies to other fungal proteins. Methods: Serum from 308 patients (150 CD, 73 UC, 7 with indeterminate colitis (lC)) and 78 healthy controls (HC) were assayed for ASCA antibodies (IgA+lgG) using the Medizym ELISA kit. Antibodies (IgA, IgG) to other fungal proteins (Fusarium species ATC20334, MP) were measured in the same samples using an in-house ELISA assay. NOD2 mutations in these patients had been identified previously using PCR. The antibody responses were compared with the known NOD2 genotype and disease phenotype of these patients. Results: ASCA was present in 56% of CD, 16% of UC, 43% of lC, and 8% of HCs. ASCA+ve status was a predictor for CD (OR 10.6 (95% CI 1.13-3.75)) and could discriminate CD from all IBD patients (OR 5.5 (95%CI 0.86-6.46)). Sensitivity of ASCA for CD was 56%, specificity was 89% and positive predictive value was 83%. ASCA was associated with ileal/ileocolonic rather than colonic disease (p<0.001), but not with NOD2 mutations. There was no association between ASCA and antibodies to MP (IgA or IgG). MP IgA titres were higher in CD than HC (p<0.01), while MP IgG titres were associated with ileal, but not ileocolonic nor colonic disease. Conclusions: ASCA was found to be a specific marker for CD and associated with disease involving the ileum, but not NOD2 mutations. MP antibody titres were higher in CD patients and independently associated with ileal disease alone. These results help to further the understanding of CD pathogenesis.


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