Antineutrophil cytoplasmic antibodies in Turkish children with inflammatory bowel disease.

Abstract

TO THE EDITOR: We have read with interest the article by Dr. Sugi et al. in the Journal, mentioning the antineutrophil cytoplasmic antibody (ANCA)-positivity in Japanese patients with inflammatory bowel diseases (IBD) (1). They have found ANCA positivity in 76.9% of ulcerative colitis (UC) and 74.4% of Crohn's disease (CD) patients, and have concluded that ANCA was useful in distinguishing patients with IBD from normal subjects but was not sufficient for the differential diagnosis of UC and CD. Although IBD in children is relatively rare in developing countries, compared to developed ones, in the last 5 yr, 12 children with IBD (five UC, three CD and four unclassified disease [UD]) have been diagnosed by clinical, laboratory, endoscopic, and histological examinations in our unit. As ANCA in children has not been widely studied, we wanted to investigate the prevalence of these antibodies in our patients. The patient population included 10 boys and two girls; both girls had UC. Age at diagnosis ranged from 2.5 to 16.5 yr (median 12 yr). Duration of symptoms before diagnosis ranged from 2 months to 4 yr (median 1 yr). Median follow-up was 2 yr (3 months to 5 yr). None had a positive family history or fulminant disease; only one needed partial cholectomy. Frequently presenting symptoms were hematochesia, diarrhea, and abdominal pain. All three patients with CD and three with UC presented with severe weight loss, anorexia, and fatigue. The most common extraintestinal manifestation was recurrent aphtous stomatitis, affecting two CD and two UD patients. Erythema nodosum, recurrent polyarthritis (2), anal fissures (2), urinary infections, and rectovaginal fistula were others. Growth retardation (height less than third) was identified in two UC, one CD, and two UD patients at diagnosis. One UD patient presented with hypoalbuminemia and clubbing. Intestinal amebiasis complicated IBD in three children (one CD, two UC). Elevated ESR and CRP were found in nine and five children, respectively, and nine had iron deficient anemia. ANCA was examined in 10 before therapy was started (active disease), and was found positive in two of four UC, one of three CD, and two of three UD patients (50%). The detection of ANCA was made by indirect immunofluorescence according to the recommendations of the international workshop on ANCA (2). Although the number of patients is small and unsuitable for statistically comparing UC to CD patients, we may conclude that ANCA positivity is about 50% in children with IBD in our country.