title: The value of serologic markers in indeterminate colitis: a prospective follow-up study.
abstract: OBJECTIVE
  In the absence of pathognomonic markers for Crohn's disease (CD) and ulcerative colitis (UC), the diagnosis of inflammatory bowel disease depends on a compendium of clinical, radiographic, endoscopic, and histologic criteria that bears imperfect specificity to the individual disorders. In 10% of cases of colitis, no differentiation can be made between CD and UC; these patients are diagnosed with indeterminate colitis (IC). We evaluated the value of anti-Saccharomyces cerevisiae antibodies (ASCA) and perinuclear antineutrophil cytoplasmic antibodies (pANCA) to increase diagnostic accuracy in categorizing IC.
  
  
  METHODS
  Since 1996, 97 patients with IC from 3 centers (Leuven, Lille, and Vienna) were enrolled, analyzed for pANCA and ASCA, and followed up prospectively.
  
  
  RESULTS
  A definitive diagnosis has been reached for 31 of 97 patients (32%). In these patients, ASCA+/pANCA- correlated with CD in 8 of 10 patients, whereas ASCA-/pANCA+ correlated with UC in 7 of 11 patients. The remaining 4 cases became CD, clinically behaving as UC-like CD. Almost half of the patients (47 of 97 [48.5%]) were negative for ASCA and pANCA, and 40 remain diagnosed with IC to date. Only 7 seronegative cases (14.9%) became CD or UC compared with 48% (24 of 50) of seropositive patients (P < 0.001).
  
  
  CONCLUSIONS
  Results so far show that ASCA+/pANCA- predicts CD in 80% of patients with IC and ASCA-/pANCA+ predicts UC in 63.6%. Interestingly, 48.5% of patients do not show antibodies against ASCA or pANCA. Most of these patients remain diagnosed with IC during their further clinical course, perhaps reflecting a distinct clinicoserological entity.
authors: Gastroenterology Unit, Department of Pathology, U.Z. Gasthuisberg, Leuven, Belgium.
authors: Sofie
authors: S
authors: Joossens
authors: Walter
authors: W
authors: Reinisch
authors: Séverine
authors: S
authors: Vermeire
authors: Boualem
authors: B
authors: Sendid
authors: Daniel
authors: D
authors: Poulain
authors: Marc
authors: M
authors: Peeters
authors: Karel
authors: K
authors: Geboes
authors: Xavier
authors: X
authors: Bossuyt
authors: Peggy
authors: P
authors: Vandewalle
authors: Georg
authors: G
authors: Oberhuber
authors: Harald
authors: H
authors: Vogelsang
authors: Paul
authors: P
authors: Rutgeerts
authors: Jean-Frédéric
authors: JF
authors: Colombel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood*; D000908:Antibodies, Fungal / Q000097:blood*; D015415:Biomarkers; D003093:Colitis, Ulcerative / Q000175:diagnosis*; D003424:Crohn Disease / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012441:Saccharomyces cerevisiae / Q000276:immunology*
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic; D000908:Antibodies, Fungal; D015415:Biomarkers