title: Serological markers in diagnosis of pediatric inflammatory bowel disease and as predictors for early tumor necrosis factor blocker therapy.
abstract: OBJECTIVE
  To describe the prevalence of serological markers in newly diagnosed treatment-naïve pediatric inflammatory bowel disease (IBD), their utility in differentiating Crohn's disease (CD), ulcerative colitis (UC) and symptomatic non-IBD patients and whether serological markers are associated with early TNF blocker treatment.
  
  
  METHODS
  Ninety-six children and adolescents <18 years, 58 with IBD and 38 symptomatic non-IBD controls were included. At diagnosis and after 1-2 years, serological antibodies (anti-Saccharomyces cerevisiae antibodies (ASCA), perinuclear anti-neutrophil cytoplasmic antibody (pANCA), flagellin expressed by Clostridial phylum (anti-CBir1), outer membrane porin of Escherichia coli (anti-OmpC), Pseudomonas fluorescens-associated sequence (anti-I2), CRP, ESR and fecal calprotectin were analyzed. The choice of treatment was made at the discretion of the treating pediatrician.
  
  
  RESULTS
  Of the IBD patients, 20 (36%) and 26 (47%) were positive for ASCA and pANCA compared to 3(8%), p < .01 and 10 (27%), p = .04 of the controls. Thirteen (72%) of UC patients were pANCA positive, versus 13 (35%) of CD patients (p < .01). None of the UC patients was ASCA positive versus 20 (54%) of CD patients (p < .0001). Compared to conventionally treated patients, the 18 (49%) TNF blocker treated CD patients had higher presence of ASCA (p < .01), lower presence of pANCA (p = .02) and higher levels of fecal calprotectin, CRP and ESR at diagnosis. In multivariate analyses ASCA and pANCA status, but not CRP, ESR or calprotectin, were independently associated with early TNF blocker treatment.
  
  
  CONCLUSIONS
  ASCA and pANCA status were associated with having IBD and with early TNF blocker treatment in CD.
authors.affiliation: a Department of Pediatric and Adolescent Medicine , Akershus University Hospital , Lørenskog, Norway.|b Institute for Clinical Medicine, Campus Ahus , University of Oslo , Oslo, Norway.
authors.forename: Christine
authors.initials: C
authors.lastname: Olbjørn
authors.affiliation: c Faculty of Health Sciences , Oslo and Akershus University College of Applied Sciences , Oslo , Norway.
authors.forename: Milada
authors.initials: M
authors.lastname: Cvancarova Småstuen
authors.affiliation: d Department of Gastroenterology, Rikshospitalet , Oslo University Hospital , Oslo , Norway.
authors.forename: Espen
authors.initials: E
authors.lastname: Thiis-Evensen
authors.affiliation: a Department of Pediatric and Adolescent Medicine , Akershus University Hospital , Lørenskog, Norway.|b Institute for Clinical Medicine, Campus Ahus , University of Oslo , Oslo, Norway.
authors.forename: Britt
authors.initials: B
authors.lastname: Nakstad
authors.affiliation: e Epigen , Institute for Clinical Medicine, Campus Ahus, University of Oslo , Oslo , Norway.
authors.forename: Morten Harald
authors.initials: MH
authors.lastname: Vatn
authors.affiliation: f Department of Pediatrics, Ullevål , Oslo University Hospital , Oslo , Norway.
authors.forename: Gøri
authors.initials: G
authors.lastname: Perminow
mesh_terms: D000068879:Adalimumab / Q000627:therapeutic use; D000293:Adolescent; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood*; D000908:Antibodies, Fungal / Q000097:blood*; D001691:Biological Therapy; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005243:Feces / Q000737:chemistry; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000097:blood* / Q000628:therapy*; D000069285:Infliximab / Q000627:therapeutic use; D039841:Leukocyte L1 Antigen Complex / Q000032:analysis; D016015:Logistic Models; D008297:Male; D009664:Norway / Q000453:epidemiology; D010372:Pediatrics; D011446:Prospective Studies; D000079424:Tumor Necrosis Factor Inhibitors
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic; D000908:Antibodies, Fungal; D015415:Biomarkers; D039841:Leukocyte L1 Antigen Complex; D000079424:Tumor Necrosis Factor Inhibitors; D000069285:Infliximab; D000068879:Adalimumab
keywords: ASCA; Crohn’s disease; IBD; TNF blocker; biologic therapy; biomarkers; pANCA; pediatric; serological markers; ulcerative colitis