TY - JOUR
T1 - PANCA and ASCA in Children with IBD-Unclassified, Crohn's Colitis, and Ulcerative Colitis - A Longitudinal Report from the IBD Porto Group of ESPGHAN
AU - Birimberg-Schwartz, Liron
AU - Wilson, David C.
AU - Kolho, Kaija Leena
AU - Karolewska-Bochenek, Katarzyna
AU - Afzal, Nadeem Ahmad
AU - Spray, Christine
AU - Romano, Claudio
AU - Lionetti, Paolo
AU - Hauer, Almuthe C.
AU - Martinez-Vinson, Christine
AU - Veres, Gabor
AU - Escher, Johanna C.
AU - Turner, Dan
N1 - Publisher Copyright:
© 2016 Crohn's & Colitis Foundation of America, Inc.
PY - 2016/5/31
Y1 - 2016/5/31
N2 - Introduction: No study to date has evaluated perinuclear antineutrophil cytoplasmic antibody (pANCA) and anti-Saccharomyces cerevisiae antibody (ASCA) in pediatric inflammatory bowel disease-unclassified (IBDU) as compared with Crohn's colitis (CC) and ulcerative colitis (UC), which represent the diagnostic challenge. We aimed to explore the diagnostic utility of serology and to assess whether serology can predict disease severity in these subgroups. Methods: This was a multicenter retrospective longitudinal study including 406 children with inflammatory bowel diseases (IBD) from 23 centers affiliated with the Porto group of European Society of Pediatric Gastroenterology, Hepatology and Nutrition (mean age 10.5 ± 3.9, 54% males); 117 (29%) with CC, 143 (35%) with UC, and 146 (36%) with IBDU. Median follow-up period was 2.8 years (interquartile range, 1.6-4.2). Results: The most prevalent serologic profile in IBDU was pANCA-/ASCA- (41%), followed by pANCA+/ASCA- (34%) and pANCA-/ASCA+ (17%). pANCA-/ASCA+ differentiated well between CC versus IBDU (83% specificity, 96% positive predictive value [PPV]) and UC (97% specificity, 90% PPV) patients, albeit with a low negative predictive value (13% and 40%, respectively). pANCA+/ASCA- did not differentiate as well between IBD subgroups, but UC children with pANCA+/ASCA- had more often severe disease at diagnosis (36 [62%] versus 22 [38%], P 0.033) and needed more often calcineurin inhibitors, biologics, or colectomy (25 [80%] versus 6 [20%], P 0.026). In CC, double positivity for ASCA and not pANCA-/ASCA+ profile was associated with disease severity. Conclusions: Serology may have some role in predicting disease course and outcomes in colonic IBD, but its routine use needs to be supported by more studies. Serology cannot routinely be recommended for differentiating between IBDU versus CC or UC as a sole diagnostic criterion given its low diagnostic utility.
AB - Introduction: No study to date has evaluated perinuclear antineutrophil cytoplasmic antibody (pANCA) and anti-Saccharomyces cerevisiae antibody (ASCA) in pediatric inflammatory bowel disease-unclassified (IBDU) as compared with Crohn's colitis (CC) and ulcerative colitis (UC), which represent the diagnostic challenge. We aimed to explore the diagnostic utility of serology and to assess whether serology can predict disease severity in these subgroups. Methods: This was a multicenter retrospective longitudinal study including 406 children with inflammatory bowel diseases (IBD) from 23 centers affiliated with the Porto group of European Society of Pediatric Gastroenterology, Hepatology and Nutrition (mean age 10.5 ± 3.9, 54% males); 117 (29%) with CC, 143 (35%) with UC, and 146 (36%) with IBDU. Median follow-up period was 2.8 years (interquartile range, 1.6-4.2). Results: The most prevalent serologic profile in IBDU was pANCA-/ASCA- (41%), followed by pANCA+/ASCA- (34%) and pANCA-/ASCA+ (17%). pANCA-/ASCA+ differentiated well between CC versus IBDU (83% specificity, 96% positive predictive value [PPV]) and UC (97% specificity, 90% PPV) patients, albeit with a low negative predictive value (13% and 40%, respectively). pANCA+/ASCA- did not differentiate as well between IBD subgroups, but UC children with pANCA+/ASCA- had more often severe disease at diagnosis (36 [62%] versus 22 [38%], P 0.033) and needed more often calcineurin inhibitors, biologics, or colectomy (25 [80%] versus 6 [20%], P 0.026). In CC, double positivity for ASCA and not pANCA-/ASCA+ profile was associated with disease severity. Conclusions: Serology may have some role in predicting disease course and outcomes in colonic IBD, but its routine use needs to be supported by more studies. Serology cannot routinely be recommended for differentiating between IBDU versus CC or UC as a sole diagnostic criterion given its low diagnostic utility.
KW - ANCA
KW - ASCA
KW - Crohn's colitis
KW - IBDU
KW - UC
KW - pediatrics
KW - prediction
UR - http://www.scopus.com/inward/record.url?scp=84979938835&partnerID=8YFLogxK
U2 - 10.1097/MIB.0000000000000784
DO - 10.1097/MIB.0000000000000784
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C2 - 27135480
AN - SCOPUS:84979938835
SN - 1078-0998
VL - 22
SP - 1908
EP - 1914
JO - Inflammatory Bowel Diseases
JF - Inflammatory Bowel Diseases
IS - 8
ER -