title: Serologic antibodies in relation to outcome in postoperative Crohn's disease.
abstract: OBJECTIVE
  Disease recurs frequently after Crohn's disease resection. The role of serological antimicrobial antibodies in predicting recurrence or as a marker of recurrence has not been well defined.
  
  
  METHODS
  A total of 169 patients (523 samples) were prospectively studied, with testing peri-operatively, and 6, 12 and 18 months postoperatively. Colonoscopy was performed at 18 months postoperatively. Serologic antibody presence (perinuclear anti-neutrophil cytoplasmic antibody [pANCA], anti-Saccharomyces cerevisiae antibodies [ASCA] IgA/IgG, anti-OmpC, anti-CBir1, anti-A4-Fla2, anti-Fla-X) and titer were tested. Quartile sum score (range 6-24), logistic regression analysis, and correlation with phenotype, smoking status, and endoscopic outcome were assessed.
  
  
  RESULTS
  Patients with ≥ 2 previous resections were more likely to be anti-OmpC positive (94% vs 55%, ≥ 2 vs < 2, P = 0.001). Recurrence at 18 months was associated with anti-Fla-X positivity at baseline (49% vs 29%; positive vs negative, P = 0.033) and 12 months (52% vs 31%, P = 0.04). Patients positive (n = 28) for all four antibacterial antibodies (anti-CBir1, anti-OmpC, anti-A4-Fla2, and anti-Fla-X) at baseline were more likely to experience recurrence at 18 months than patients negative (n = 32) for all four antibodies (82% vs 18%, P = 0.034; odds ratio 6.4, 95% confidence interval 1.16-34.9). The baseline quartile sum score for all six antimicrobial antibodies was higher in patients with severe recurrence (Rutgeert's i3-i4) at 18 months, adjusted for clinical risk factors (odds ratio 1.16, 95% confidence interval 1.01-1.34, P = 0.039). Smoking affected antibody status.
  
  
  CONCLUSIONS
  Anti-Fla-X and presence of all anti-bacterial antibodies identifies patients at higher risk of early postoperative Crohn's disease recurrence. Serologic screening pre-operatively may help identify patients at increased risk of recurrence.
authors.affiliation: Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia.|Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Amy L
authors.identifier: http://orcid.org/0000-0002-1627-2057
authors.initials: AL
authors.lastname: Hamilton
authors.affiliation: Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia.|Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Kamm
authors.affiliation: Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia.|Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.|Austin Health, Melbourne, Victoria, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: De Cruz
authors.affiliation: Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia.|Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Emily K
authors.initials: EK
authors.lastname: Wright
authors.affiliation: Prometheus Laboratories, San Diego, California, USA.
authors.forename: Fabiyola
authors.initials: F
authors.lastname: Selvaraj
authors.affiliation: Prometheus Laboratories, San Diego, California, USA.
authors.forename: Fred
authors.initials: F
authors.lastname: Princen
authors.affiliation: Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Victoria, Australia.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Gorelik
authors.affiliation: Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Danny
authors.initials: D
authors.lastname: Liew
authors.affiliation: School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia.|Centre for Inflammatory Bowel Diseases, Saint John of God Hospital, Subiaco, Western Australia, Australia.|Harry Perkins Institute for Medical Research, Nedlands, Western Australia, Australia.|Fiona Stanley Hospital, Perth, Western Australia, Australia.
authors.forename: Ian C
authors.initials: IC
authors.lastname: Lawrance
authors.affiliation: Department of Gastroenterology and Hepatology, University of Adelaide, Adelaide, South Australia, Australia.|Royal Adelaide Hospital, Adelaide, South Australia, Australia.
authors.forename: Jane M
authors.initials: JM
authors.lastname: Andrews
authors.affiliation: Department of Gastroenterology and Hepatology, Flinders Medical Centre and Flinders University, Adelaide, South Australia, Australia.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Bampton
authors.affiliation: Department of Gastroenterology, Alfred Health, Melbourne, Victoria, Australia.
authors.forename: Miles P
authors.initials: MP
authors.lastname: Sparrow
authors.affiliation: Immunity Infection and Inflammation Program, Mater Research Institute-University of Queensland, and School of Medicine, University of Queensland, Brisbane, Queensland, Australia.|Translational Research Institute, Woolloongabba, Queensland, Australia.
authors.forename: Timothy H
authors.initials: TH
authors.lastname: Florin
authors.affiliation: Department of Gastroenterology, Alfred Health, Melbourne, Victoria, Australia.|Department of Gastroenterology, Monash University, Melbourne, Victoria, Australia.
authors.forename: Peter R
authors.initials: PR
authors.lastname: Gibson
authors.affiliation: Melbourne Gastrointestinal Investigation Unit, Cabrini Hospital, Melbourne, Victoria, Australia.
authors.forename: Henry
authors.initials: H
authors.lastname: Debinski
authors.affiliation: Department of Medicine, University of Otago, Christchurch, New Zealand.
authors.forename: Richard B
authors.initials: RB
authors.lastname: Gearry
authors.affiliation: Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.|Department of Colorectal Medicine and Genetics, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors.forename: Finlay A
authors.initials: FA
authors.lastname: Macrae
authors.affiliation: Gastroenterology and Liver Services, Concord and Bankstown Hospitals and University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Rupert W
authors.initials: RW
authors.lastname: Leong
authors.affiliation: Department of Gastroenterology, Western Hospital, Melbourne, Victoria, Australia.
authors.forename: Ian
authors.initials: I
authors.lastname: Kronborg
authors.affiliation: Department of Gastroenterology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.|IBD Group Queensland Institute of Medical Research, University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Graham
authors.initials: G
authors.lastname: Radford-Smith
authors.affiliation: AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
authors.forename: Warwick
authors.initials: W
authors.lastname: Selby
authors.affiliation: Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia.|Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Sally J
authors.initials: SJ
authors.lastname: Bell
authors.affiliation: Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Brown
authors.affiliation: Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia.
authors.forename: William R
authors.initials: WR
authors.lastname: Connell
mesh_terms: D000328:Adult; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood; D000907:Antibodies, Bacterial / Q000097:blood; D015415:Biomarkers / Q000097:blood; D003113:Colonoscopy; D003424:Crohn Disease / Q000175:diagnosis* / Q000601:surgery*; D005260:Female; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood; D007074:Immunoglobulin G / Q000097:blood; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D059035:Perioperative Period; D018272:Porins / Q000276:immunology; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012306:Risk; D012441:Saccharomyces cerevisiae / Q000276:immunology; D012907:Smoking / Q000009:adverse effects
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic; D000907:Antibodies, Bacterial; D015415:Biomarkers; D007070:Immunoglobulin A; D007074:Immunoglobulin G; C113724:OmpC protein; D018272:Porins
keywords: Crohn's disease; antibodies; postoperative; serology; smoking