Sunday, February 20, 2011

IBD markers are not screening tools

Again, I am fascinated by how some physicians order an "IBD panel" in a kid with abdominal pain to r/o Crohn's disease (CD) or Ulcerative colitis (UC). Unless I am confused, an IBD panel's role is to help differentiate the two types of IBD, and not make the diagnosis (substantial false positives and false negatives).

Here is some information I found useful:

Main laboratory markers:

ANCA: anti-neutrophil cytoplasm antibody
ASCA: anti-Saccharomyces cervisiae antibody
Anti-OmpC: anti E coli-related outer membrane porin C
Anti I2
Anti-Cbir1: antibody against flagellin

pANCA present in two thirds of UC patients and one third of CD
pANCA-positive CD patients have a clinical picture similar to UC
ASCA (IgG or IgA) present in half of patients with CD
High titers of ASCA in the absence of pANCA highly predictive of CD
Antibodies to OmpC and I2 are associated with more strictures and internal perforations
Anti-Cibr1 associated with CD, particularly penetrating disease, fibrosing disease, and SB involvement.
pANCA positive CD patients less likely to respond to inflixamab than ASCA positive or totally seronegative

Reference:
Wyllie R, Hyams JS, Kay M (2011). Crohn's Disease. In Wyllie R, Hyams JS, Kay M (Edx.), Pediatric Gastrointestinal and Liver Disease 4th ed (pp 462-489). Elsevier.
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This publication from the Mayo clinic is concise and useful too.

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