Serological markers in diagnosis of pediatric inflammatory bowel disease and as predictors for early tumor necrosis factor blocker therapy
Olbjørn, Christine; Småstuen, Milada Cvancarova; Thiis-Evensen, Espen; Nakstad, Britt; Vatn, Morten H; Perminow, Gøri Margrete
Journal article, Peer reviewed
Accepted version
Date
2016-11-25Metadata
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Original version
Olbjørn C, Småstuen MC, Thiis-Evensen E, Nakstad B, Vatn MH, Perminow GM. Serological markers in diagnosis of pediatric inflammatory bowel disease and as predictors for early tumor necrosis factor blocker therapy. Scandinavian Journal of Gastroenterology. 2017;52(4):414-419 http://dx.doi.org/10.1080/00365521.2016.1259653Abstract
Objective: To describe the prevalence of serological markers in newly diagnosed treatment
naïve pediatric inflammatory bowel disease (IBD), their utility in differentiating Crohn’s
disease (CD), ulcerative colitis (UC) and symptomatic non-IBD patients and whether
serological markers are associated with early TNF blocker treatment.
Material and methods: Ninety-six children and adolescents < 18 years, 58 with IBD and 38
symptomatic non-IBD controls were included. At diagnosis and after 1-2 years, serological
antibodies (anti–Saccharomyces cerevisiae antibodies (ASCA), perinuclear anti-neutrophil
cytoplasmic antibody (pANCA), flagellin expressed by Clostridial phylum (anti-CBir), outer
membrane porin of Escherichia coli (anti-OmpC), Pseudomonas fluorescens associated
sequence (anti-I2)), CRP, ESR, and fecal calprotectin were analyzed. The choice of treatment
was made at the discretion of the treating pediatrician.
Results: Of the IBD patients 20 (36%) and 26 (47%) were positive for ASCA and pANCA
compared to 3(8%), p<0.01 and 10 (27%), p=0.04 of the controls. Thirteen (72%) of UC
patients were pANCA positive, versus 13 (35%) of CD patients (p<0.01). None of the UC
patients was ASCA positive versus 20 (54%) of CD patients (p<0.0001). Compared to
conventionally treated patients, the 18 (49%) TNF blocker treated CD patients had higher
presence of ASCA (p<0.01) lower presence of pANCA (p=0.02) and higher levels of fecal
calprotectin, CRP and ESR at diagnosis. In multivariate analyses ASCA and pANCA status,
but not CRP, ESR or calprotectin, were independently associated with early TNF blocker
treatment.
Conclusions: ASCA and pANCA status were associated with having IBD and with early
TNF blocker treatment in CD.