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Title: Serologic antibodies in relation to outcome in postoperative Crohn's disease
Authors: Hamilton, Amy L;Kamm, Michael A;De Cruz, Peter;Wright, Emily K;Selvaraj, Fabiyola;Princen, Fred;Gorelik, Alexandra;Liew, Danny;Lawrance, Ian C;Andrews, Jane M;Bampton, Peter A;Sparrow, Miles P;Florin, Timothy H;Gibson, Peter R;Debinski, Henry;Gearry, Richard B;Macrae, Finlay A;Leong, Rupert W;Kronborg, Ian;Radford-Smith, Graham;Selby, Warwick;Bell, Sally J;Brown, Steven J;Connell, William R
Issue Date: Jun-2017
EDate: 2017-05-30
Citation: Journal of Gastroenterology and Hepatology 2017; 32(6): 1195-1203
Abstract: BACKGROUND AND AIM: 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.
DOI: 10.1111/jgh.13677
PubMed URL:
Type: Journal Article
Subjects: Crohn's disease
Appears in Collections:Journal articles

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