Effects of age at disease onset and at treatment on serology in inflammatory bowel diseases.

Abstract

To the Editor, I read with great interest the paper by Truta et al. [1] about the potential of recently introduced serological markers in predicting the risk of Crohn’s disease (CD) of the pelvic pouch in patients diagnosed with ulcerative colitis (UC) undergoing restorative proctocolectomy with ileal pouch– anal anastomosis (IPAA). The authors found that a positive serology for anti-CBir1 was independently associated with developing post-IPAA CD. In addition, anti-Saccaromyces cerevisiae antibodies (ASCA) positivity did not predict development of pouch CD. These data are very interesting, although not completely new. Specifically, Coukos et al. [2] published in 2012 in Digestive Diseases and Sciences their experience with serological predictors of pouch CD after IPAA. In their retrospective series of 142 UC patients undergoing IPAA, 44 of whom developing complications, they found antiCBir1 and ASCA IgG useful to predict fistulae and CD of the pouch [2]. A comment to prior findings by the authors would have been desirable. The potential of the present research is the possibility of better selecting candidates to IPAA, in order to avoid pelvic sepsis, the bete noire of the procedure, associated with poor functional outcomes, quality of life and pouch retention rate in the long term [3]. Any effort should be made to identify noninvasive markers predicting CD of the pouch. I would add a consideration to the findings of Truta et al. [1]. A facet one should consider when dealing with serology of patients with inflammatory bowel disease is age at diagnosis and age at surgery. For example, pediatric UC patients have more aggressive disease [4, 5], with higher colectomy rates, presumably related to a more active immune status. Concerning serology of young patients, it has been reported that younger CD patients are more likely to express anti-CBir1, but only half is as likely to express ASCA [4]. In the study by Truta et al. [1], age at diagnosis was significantly lower in the ‘‘case’’ group. This may have influenced the results. Given that IPAA can be performed at any age [5, 6], age at diagnosis should be posed into perspective when trying to identify serological markers of individuals with such dynamic and active autoimmunity as UC and CD patients are [7, 8].