Gastroenterology

Gastroenterology

Volume 110, Issue 6, June 1996, Pages 1810-1819
Gastroenterology

Perinuclear antineutrophil cytoplasmic antibodies in patients with Crohn's disease define a clinical subgroup

https://doi.org/10.1053/gast.1996.v110.pm8964407Get rights and content

Abstract

BACKGROUND & AIMS: Antineutrophil cytoplasmic antibodies (ANCA) have been consistently detected in a subgroup of patients with Crohn's disease (CD). This study was designed to determine whether serum ANCA expression in patients with CD characterizes an identifiable clinical subgroup. METHODS: The study population consisted of 69 consecutive patients with an established diagnosis of CD as determined by a combination of characteristic clinical, radiographic, endoscopic, and histopathologic criteria. Sera from the patients were analyzed for the presence of ANCAs using the fixed neutrophil enzyme-linked immunosorbent assay (ELISA) assay. Perinuclear ANCA (pANCA)-positive and cytoplasmic ANCA (cANCA)-positive results by ELISA were confirmed by indirect immunofluorescence staining. Clinical profiles of the ANCA- positive patients with CD were compared with those of patients with CD not expressing ANCA (ANCA-negative). RESULTS: pANCA-positive patients with CD have endoscopically and/or histopathologically documented left- sided colitis and symptoms of left-sided colonic inflammation, clinically reflected by rectal bleeding and mucus discharge, urgency, and treatment with topical agents. One hundred percent of patients with CD expressing pANCA had "UC-like" features. CONCLUSIONS: In patients with CD, serum pANCA expression characterizes a UC-like clinical phenotype. Stratification of CD by serum pANCA provides evidence of heterogeneity within CD and suggests a common intestinal mucosal inflammatory process among a definable subgroup of patients with CD and UC expressing this marker. (Gastroenterology 1996 Jun;110(6):1810-9)

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    Citation Excerpt :

    It is possible that these patients have subclinical IBD and further studies are required to answer this question. In IBD, the presence of certain antibodies has clinical significance; in Crohn disease, ASCA are associated with younger age of onset and small bowel involvement,50 whereas antineutrophil cytoplasmic antibodies are associated with ulcerative colitis–like features.51 Anti-CBir1 antibodies are associated with fibrostenosing disease and complicated small bowel disease.52

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