title: Utility of fecal and serum anti-Saccharomyces cerevisiae antibodies in the diagnosis of Crohn's disease-like condition of the pouch.
abstract: 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.
  
  
  OBJECTIVE
  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.
authors.affiliation: Pouchitis Clinic, Digestive Disease Institute/A31, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
authors.forename: Linda Y
authors.initials: LY
authors.lastname: Tang
authors.forename: Hui
authors.initials: H
authors.lastname: Cai
authors.forename: Udayakumar
authors.initials: U
authors.lastname: Navaneethan
authors.forename: James H
authors.initials: JH
authors.lastname: Boone
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Rhodes
authors.forename: Lauren
authors.initials: L
authors.lastname: Moore
authors.forename: Hyunjin
authors.initials: H
authors.lastname: Rho
authors.forename: Carol
authors.initials: C
authors.lastname: de La Motte
authors.forename: Elaine
authors.initials: E
authors.lastname: Queener
authors.forename: Bo
authors.initials: B
authors.lastname: Shen
mesh_terms: D000908:Antibodies, Fungal / Q000097:blood*; D039021:Colonic Pouches / Q000276:immunology / Q000382:microbiology*; D003424:Crohn Disease / Q000097:blood / Q000175:diagnosis* / Q000276:immunology*; D003710:Demography; D003937:Diagnosis, Differential; D004724:Endoscopy; D005243:Feces / Q000382:microbiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D012372:ROC Curve; D012441:Saccharomyces cerevisiae / Q000276:immunology*
chemical_list: D000908:Antibodies, Fungal