Utility of fecal and serum anti-Saccharomyces cerevisiae antibodies in the diagnosis of Crohn’s disease-like condition of the pouch

• Published in: International journal of colorectal disease Vol. 27; no. 11; pp. 1455 - 1463
• Main Authors: Tang, Linda Y., Cai, Hui, Navaneethan, Udayakumar, Boone, James H., Rhodes, Sarah J., Moore, Lauren, Rho, Hyunjin, de La Motte, Carol, Queener, Elaine, Shen, Bo
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.11.2012; Springer; Springer Nature B.V
• Subjects: Antibodies; Antibodies, Fungal - blood; Bacteria; Biological products; Colonic Pouches - immunology; Colonic Pouches - microbiology; Crohn Disease - blood; Crohn Disease - diagnosis; Crohn Disease - immunology; Crohn's disease; Demography; Diagnosis, Differential; Differential diagnosis; Endoscopy; Enzyme-linked immunosorbent assay; Enzymes; Familial adenomatous polyposis; Feces; Feces - microbiology; Female; Gastroenterology; Hepatology; Humans; Inflammation; Internal Medicine; Male; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Middle Aged; Mucosal immunity; Original Article; Phenotype; Proctology; Rankings; ROC Curve; Saccharomyces cerevisiae - immunology; Statistical analysis; Surgery; Viral antibodies; Restorative proctocolectomy; Fecal; ASCA; Ileal pouch; Crohn’s disease
• ISSN: 0179-1958; 1432-1262
• DOI: 10.1007/s00384-012-1444-4

Background Fecal antibodies against bacterial products may directly reflect the interaction between luminal bacteria and mucosal immunity, and assays for these antibodies may be clinically useful in the diagnosis and differential diagnosis of Crohn’s disease-like (CDL) condition of the pouch. Aims This study aims to evaluate stool and serum anti- Saccharomyces cerevisiae antibodies (ASCA) in normal and diseased pouches, to assess the correlation between ASCA levels and endoscopic disease activity, and to ascertain the diagnostic utility of ASCA for CDL of the pouch. Methods One hundred eighty-nine patients with ileal pouches were prospectively enrolled and corresponding serum and pouch aspirate samples were collected. Fecal and serum ASCA levels were measured with enzyme-linked immunosorbent assay in a blinded fashion. Statistical analysis was then conducted using the signed rank test, Spearman correlation coefficients, and analysis of variance. Results Forty-three patients (22.8 %) had irritable pouch syndrome or normal pouches, 74 (39.2 %) had pouchitis/cuffitis, 52 (27.5 %) had CDL, 9 (4.8 %) had familial adenomatous polyposis, and 11 (5.8 %) had surgical complications of the pouch. Receiver operating characteristic curves to distinguish CDL from other categories of pouch dysfunction had an area under the curve (AUC) of 0.608 for fecal ASCA and an AUC of 0.517 for serum ASCA. Neither fecal nor serum ASCA correlated with endoscopic disease activity scores. There was a significant difference in the mean values of fecal ASCA between inflammatory and fistulizing CDL (0.27 vs. 0.03 ELISA units/ml, P  < 0.05). Conclusions Fecal ASCA appears to be better than serum ASCA in differentiating CDL from other pouch disorders, although this distinction may be of limited clinical utility.