Annual Meeting of the North American Society for Pediatric Gastroenterology and Nutrition; Orlando, October 22-24, 1998
PEDIATRIC PATIENTS WITH INDETERMINATE COLITIS ARE ANCA, NOT ASCA POSITIVE
Previously, we showed that perinuclear anti-neutrophil cytoplasmic antibody (pANCA) and anti-Saccharomyces cerevisiae (ASCA) assays are highly disease specific for ulcerative colitis (UC) and Crohn's disease (CD), respectively. However, 10-15% of pediatric patients presenting with colitis defy clear categorization into UC or CD. These patients are commonly referred to as indetermine colitis (IC). Aim: to characterize pediatric patients with IC using the pANCA and ASCA assays. Methods: Serum specimens from 228 patients were obtained and analyzed in a blinded, coded manner at Prometheus Laboratories (San Diego, CA) for the presence of IgA/IgG ASCA or ANCA by ELISA. pANCA was confirmed by indirect immunofluorescence followed by DNase treatment. On the basis of standard investigation, IBD patients were grouped into CD or UC. A third group consisted of patients whose initial endoscopic and histopathological diagnosis was that of an indetermine colitis (IC). The remaining non-IBD-controls consisted of patients with irritable bowel syndrome (27), eosinophilic colitis (16), acute bacterial colitis (10). Results: (Table)
χ2 *p<0.001 IC versus CD. In one patient initially classified as IC, further investigations led to a definitive diagnosis of UC (after 2 years). The initial serological work-up already revealed a positive pANCA panel. Conclusions: Our serological data suggest that children with IC, whose clinical and histological findings defy a clear classification into UC or CD, are likely to have a mild form of ulcerative colitis. Supported by the FRSQ, CCFC and DFG.
Abdominal Pain/IBD/Outcomes© 1998 Lippincott Williams & Wilkins, Inc.