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Anti saccharomyces cerevisiae antibodies in crohns disease stability over time and correlation with clinical characteristics


, : Anti saccharomyces cerevisiae antibodies in crohns disease stability over time and correlation with clinical characteristics. Digestive Disease Week Abstracts & Itinerary Planner : Abstract No S1316

Background and Aims:ASCA is a serologic marker that may help in the diagnosis of Crohn's disease(CD) with a sensitivity of 60-70%. The value of serial ASCA measurements in CD is unclear. We assessed the stability of ASCA in CD patients followed prospectively with repeated measures during a 1 year period. The relationship of ASCA with various clinical characteristics was also evaluated. Methods: 78 CD patients in remission had ASCA measured every 3 months up to 1 year or earlier if they relapsed. ASCA was measured using the QUANTA Lite kit (IgA,IgG) (Inova diagnostics, San Diego). Serum values were interpreted using cut-offs provided by the manufacturer (<20.0=negative,20.1-24.9=equivocal, >25=positive). ASCA was also measured at 1 timepoint in 70 non-IBD healthy controls. Relapse was defined as a CDAI>150 with a 70 point increase from baseline. The association of ASCA with: age, age at diagnosis, gender, smoking status, disease site and duration, extra-intestinal symptoms and immunosuppressant use was assessed by multivariate analyisis. Results: At baseline, 45 patients were ASCA+ compared to 8 ASCA+ controls (p=<0.001). 2 patients and 3 controls were ASCA equivocal. The sensitivity and specificity of ASCA for CD was 60% and 88% respectively (excluding equivocals). 44 patients remained in remission at 1 year and 34 relapsed. In non-relapsers with 4 or 5 measurements (n=42), 83% (95% CI, 70-92%) maintained the same ASCA (+ or -) throughout the year. In relapsers, with 4 or 5 measurements (n=14), 64 % (95%CI, 38-86%) remained unchanged. Overall, ASCA status remained unchanged in 79% (n=44)(95%CI,66-88%) of patients with 4 or 5 measurements. In patients with equivocal ASCA (n=19) at some timepoint, 47%(95%CI,27-69%) remained equivocal, 37% (95%CI,18-60%) became negative and 16% (95%CI,4-37%) changed to positive at next measurement. No relapsers who were ASCA - at baseline remission converted to ASCA + at relapse. Also, mean IgA and IgG levels decreased from the remission state to relapse (IgA, 37 to 29, p= 0.04 ; IgG, 45 to 34, p=0.01 ). When assessing clinical factors an association between ASCA and older age at diagnosis (p=0.03) was found. Conclusion: This study demonstrates that ASCA is a stable marker when measured over a 1 year period and only few patients switch ASCA status regardless of disease activity.Therefore,repeating measurements in view of increasing the yield of a positive result is likely of little benefit. Also, ASCA was associated with older age at diagnosis.

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