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|Title:||Serologic antibodies in relation to outcome in postoperative Crohn's disease|
De Cruz, P.
|Citation:||Journal of Gastroenterology and Hepatology, 2017; 32(6):1195-1203|
|Amy L Hamilton, Michael A Kamm, Peter De Cruz, Emily K Wright, Fabiyola Selvaraj, Fred Princen, Alexandra Gorelik, Danny Liew, Ian C Lawrance, Jane M Andrews, Peter A Bampton, Miles P Sparrow, Timothy H Florin, Peter R Gibson, Henry Debinski, Richard B Gearry, Finlay A Macrae, Rupert W Leong, Ian Kronborg, Graham Radford, Smith, Warwick Selby, Sally J Bell, Steven J Brown and William R Connell|
|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 preoperatively may help identify patients at increased risk of recurrence.|
|Keywords:||antibodies; Crohn's disease; postoperative; serology; smoking|
|Description:||Accepted for publication 11 December 2016|
|Rights:||© 2016 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd|
|Appears in Collections:||Medicine publications|
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