Alimentary TractClinical significance of anti-Saccharomyces cerevisiae antibody (ASCA) in Korean patients with Crohn's disease and its relationship to the disease clinical course
Introduction
Crohn's disease (CD) is a chronic inflammation of the alimentary tract anywhere between the mouth and anus. Inflammation in CD is often discontinuous along the longitudinal axis of the gut, though it may involve all layers from the mucosa to serosa. Genetic and environmental factors are believed to play a role in CD etiology and pathogenesis [1].
Environmental factors (especially dietary components) have long been suspected to play a role in CD pathogenesis. In the late 1980s, Main et al. [2] first described elevated anti-S. cerevisiae antibody (ASCA) levels in CD patient serum. These antibodies are directed against the phosphopeptidomannans found in the cell wall of baker's and brewer's yeast (S. cerevisiae). Expression of this marker antibody reflects a specific mucosal immune-mediated response [2], [3].
The ASCA frequency in CD patients ranges from 50 to 80% of total IgG and 30–50% of total IgA antibodies [2], [3], [4], [5], [6]. ASCA testing provides clinicians with an additional diagnostic tool to differentiate possible inflammatory bowel disease (IBD) or indeterminate colitis [6]. Several studies have investigated the clinical value of measuring ASCA in CD patients. These reports have associated ASCA with several disease features, such as small bowel disease, earlier age of onset, fibrostenosis and penetrating disease and aggressive disease requiring surgical treatment [4], [5]. On the other hand, other studies suggest that ASCA is independent of disease activity, operative treatment or response to medical treatments [3], [5], [6]. Thus, a relationship between ASCA expression and CD clinical course is controversial.
In the present study, we aimed to evaluate whether ASCA expression is associated with clinical findings at diagnosis, stratified Vienna classification phenotype, disease activity and clinical course in Korean CD patients.
Section snippets
Patients and CD diagnosis
One hundred and fifteen CD patients, tested for ASCA expression, diagnosed and treated from January 1990 to December 2004 at Severance Hospital, Yonsei University College of Medicine, Seoul Korea, and followed for at least 2 years, were enrolled in this study. An additional 45 healthy people were enrolled as controls. A CD diagnosis was established by endoscopic, radiological and histological findings based on Japanese criteria [7], [8].
Serum samples from patients and healthy controls were
Mean age and gender
The ASCA prevalence was 38.3% (44/115) among CD patients and 8.8% (4/45) among healthy controls. The mean follow-up duration among the CD patients was 54.5 months (range, 24–150). The mean follow-up duration was 54.7 months (range, 24–150) among ASCA positive patients and 54.4 months (range, 24–129) among ASCA negative patients. There was no difference in ASCA expression between genders. The mean age at diagnosis was younger for the ASCA positive group than the negative group (Table 1).
Clinical manifestations and laboratory findings
The most
Discussion
CD is a heterogeneous inflammatory disease manifesting with diverse clinical features. There are reports that serological markers (p-ANCA in ulcerative colitis and ASCA in CD) can assist in the diagnosis and estimation of an IBD's clinical course. ASCA might differentiate CD from other IBDs, predict disease location or predict complications prior to their appearance. In clinical practice, ASCA could be of significant value, but the results have not been consistent between studies.
Studies have
Conflict of interest statement
None declared.
References (31)
- et al.
Diagnostic accuracy of serological assays in pediatric inflammatory bowel disease
Gastroenterology
(1998) - et al.
A review of activity indices and efficacy endpoints for clinical trials medical therapy in adults with Crohn's disease
Gastroenterology
(2002) - et al.
Detection of anti-Saccharomyces cerevisiae antibodies in Crohn's disease: is it a reliable diagnostic and prognostic marker?
Dig Liver Dis
(2001) - et al.
Anti-Saccharomyces cerevisiae mannan antibodies and antineutrophil cytoplasmic autoantibodies in Greek patients with inflammatory bowel disease
Am J Gastrenterol
(2001) - et al.
Serological markers in inflammatory bowel disease
Best Pract Res Clin Gastroenterol
(2003) Anti-Saccharomyces cerevisiae antibodies in inflammartory bowel disease
Clin Appl Immunol Rev
(2001)- et al.
Crohn's disease: influence of age at diagnosis on site and clinical type of disease
Gastroenterology
(1996) - et al.
Clinical characteristics of Crohn's disease in 72 families
Gastroenterology
(1996) - et al.
Inflammatory bowel disease
- et al.
Antibody to Saccharomyces cerevisiae (bakers’ yeast) in Crohn's disease
Br Med J
(1988)
Specific antibody response to oligomannosidic epitopes in Crohn's disease
Clin Diagn Lab Immunol
Marker antibody expression stratifies Crohn's disease into immunologically homogenous subgroups with distinct clinical characteristics
Gut
Anti-Saccharomyces antibodies (ASCA), phenotypes of IBD, and intestinal permeability: a study in IBD families
Inflamm Bowel Dis
Criteria for diagnosis of Crohn's disease (preliminary proposal)
Crohn's disease in Japan: diagnostic criteria and epidemiology
Dis Colon Rectum
Cited by (21)
Anti-Saccharomyces cerevisiae IgG and IgA antibodies are associated with systemic inflammation and advanced disease in hidradenitis suppurativa
2020, Journal of Allergy and Clinical ImmunologyMannose-binding lectin deficiency is not associated with Anti-Saccharomyces cerevisiae antibody in Korean Crohn's disease patients
2014, Clinica Chimica ActaCitation Excerpt :Our results were in agreement with those of a large Hungarian cohort in which MBL deficiency was not associated with CD and was not predictive of clinical features. In our study, the frequency of ASCA positivity was 48.1%, which was similar to that of previous studies conducted in Korean CD patients, ranging from 38.3% to 49.4% [37–39]. ASCA positivity is associated with the clinical features of CD, which suggests that ASCA might be useful in clinical practice as a preclinical or prognostic marker.
Diagnostic utility of anti-Saccharomyces cerevisiae antibody (ASCA) and Interferon-? assay in the differential diagnosis of Crohn's disease and intestinal tuberculosis
2011, Clinica Chimica ActaCitation Excerpt :In our study, both ASCA positivity (44.4%) and the mean ASCA IgG titer (25.43 ± 19.26 Units) were significantly higher in CD patients than ITB patients and healthy controls. The frequency of ASCA positivity was similar to that reported previously for Korean subjects [18, 19]. The sensitivity, specificity, PPV, and NPV of ASCA for the diagnosis of CD, in patients who suspected for CD or ITB based on clinical symptoms and colonoscopic findings, were 43%, 90.6%, 81.6% and 62.4%, respectively.
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