INFLAMMATORY BOWEL DISEASE

Anti-Saccharomyces cerevisiae antibody (ASCA) positivity is associated with increased risk for early surgery in Crohn’s disease

D G Forcione, M J Rosen, J B Kisiel, B E Sands

Gastrointestinal Unit and Center for the Study of Inflammatory Bowel Disease, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

Correspondence to:
Correspondence to:
Dr B E Sands
Gastrointestinal Unit and Center for the Study of Inflammatory Bowel Disease, Massachusetts General Hospital, 55 Fruit St, GRJ 7, Boston, MA 02114, USA; bsands{at}partners.org

Background: Anti-Saccharomyces cerevisiae antibodies (ASCA) are a specific but only moderately sensitive diagnostic marker for Crohn’s disease. We sought to explore the role of ASCA as a prognostic marker for aggressive disease phenotype in Crohn’s disease.

Aims: To determine the role of ASCA status as a risk factor for early surgery in Crohn’s disease.

Subjects: We performed a case control study in a cohort of patients, newly diagnosed with Crohn’s disease, between 1991 and 1999. All patients were followed for at least three years. Case subjects (n = 35) included those who had major surgery for Crohn’s disease within three years of diagnosis. Controls (n = 35) included patients matched to cases for age, sex, disease location, and smoking status, and who did not undergo major surgery for Crohn’s disease within three years of diagnosis.

Methods: Blinded assays were performed on serum for ASCA (immunoglobulin (Ig)A and IgG). A paired analysis of cases-controls was performed to test for the association between ASCA status and risk of early surgery.

Results: ASCA IgA was strongly associated with early surgery (odds ratio (OR) 8.5 (95% confidence interval (CI) 2.0–75.9); p = 0.0013). ASCA IgG+ and ASCA IgG+/IgA+ patients were also at increased risk for early surgery (OR 5.5 (95% CI 1.2–51.1), p = 0.0265; and OR 5.0 (95% CI 1.1–46.9), p = 0.0433, respectively). The association between ASCA and early surgery was evident in patients requiring surgery for ileal or ileocolonic disease.

Conclusions: Patients with Crohn’s disease who are positive for ASCA IgA, IgG, or both, may define a subset of patients with Crohn’s disease at increased risk for early surgery.

Abbreviations: ASCA, anti-Saccharomyces cerevisiae antibodies; pANCA, perinuclear antineutrophil cytoplasmic antibodies; OmpC, Escherichia coli outer membrane porin C; CD, Crohn’s disease; OR, odds ratio; TNF, tumour necrosis factor; Ig, immunoglobulin

Keywords: Crohn’s disease; serology; surgery; case control study; inflammatory bowel disease

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