Gastroenterology

Gastroenterology

Volume 122, Issue 5, May 2002, Pages 1242-1247
Gastroenterology

Clinical Research
The value of serologic markers in indeterminate colitis: A prospective follow-up study,☆☆

https://doi.org/10.1053/gast.2002.32980Get rights and content

Abstract

Background & Aims: 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.

GASTROENTEROLOGY 2002;122:1242-1247

Section snippets

Patients

This study involved a collaborative effort of 3 European university hospital centers in Leuven, Belgium; Lille, France; and Vienna, Austria. The study began in 1996. Patients with IC were accessioned, whether they had IBD for some time or whether they were newly classified. The follow-up time from inclusion was at least 1 year for each patient. Whole venous blood was obtained at the time of inclusion. Serum was separated by centrifugation, and aliquots were stored at −30°C.21 Ninety-seven

Results

Ninety-seven patients with IC were included in this prospective study. No differences in female/male ratio, age, age at onset, and duration of disease were seen among the 3 centers. At the time of inclusion, 88 patients had IBD for some time and 9 patients were newly classified. The mean duration of disease was 9.9 years (range, 1–39 years).

Thus far, the disease in 31 of 97 patients (32%) has evolved to the point that a definitive diagnosis has been rendered (Leuven, n = 8; Lille, n = 18;

Discussion

In most cases of IBD, a differentiation between CD and UC can be achieved with conventional diagnostic methods. However, an exact diagnosis cannot be made in approximately 10% of patients with colitis, and these patients are classified as having IC.5 Excellent Scandinavian epidemiologic studies have shown that 5% to 23% of all initial diagnoses of IBD are IC31, 32 and that the incidence of IC is 2.4 per 100,000.33 Despite the fact that IC is a rather temporary diagnosis and that up to 80% of

Acknowledgements

The authors thank Verena Kratzer for excellent technical assistance.

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  • Cited by (0)

    Address requests for reprints to: Paul Rutgeerts, M.D., Department of Gastroenterology, U.Z. Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium. e-mail: [email protected]; fax: (32) 16-344419.

    ☆☆

    Supported by a grant of the Funds for Scientific Research (Brussels, Belgium) and by a private grant by A. Lazzari. S.V. is aspirant of the FWO Belgium.

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