The value of serologic markers in indeterminate colitis: a prospective follow-up study.
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.
Joossens
Sofie
S
Gastroenterology Unit, Department of Pathology, U.Z. Gasthuisberg, Leuven, Belgium.
Reinisch
Walter
W
Vermeire
Séverine
S
Sendid
Boualem
B
Poulain
Daniel
D
Peeters
Marc
M
Geboes
Karel
K
Bossuyt
Xavier
X
Vandewalle
Peggy
P
Oberhuber
Georg
G
Vogelsang
Harald
H
Rutgeerts
Paul
P
Colombel
Jean-Frédéric
JF
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*
D019268:Antibodies, Antineutrophil Cytoplasmic; D000908:Antibodies, Fungal; D015415:Biomarkers