Serologic antibodies in relation to outcome in postoperative Crohn's disease.

Abstract

Disease recurs frequently after Crohn's disease resection. The role of serological antimicrobial antibodies in predicting recurrence or as a marker of recurrence has not been well defined. A total of 169 patients (523 samples) were prospectively studied, with testing peri-operatively, and 6, 12 and 18months postoperatively. Colonoscopy was performed at 18months postoperatively. Serologic antibody presence (perinuclear anti-neutrophil cytoplasmic antibody [pANCA], anti-Saccharomyces cerevisiae antibodies [ASCA] IgA/IgG, anti-OmpC, anti-CBir1, anti-A4-Fla2, anti-Fla-X) and titer were tested. Quartile sum score (range 6-24), logistic regression analysis, and correlation with phenotype, smoking status, and endoscopic outcome were assessed. Patients with ≥2 previous resections were more likely to be anti-OmpC positive (94% vs 55%, ≥2 vs <2, P=0.001). Recurrence at 18months was associated with anti-Fla-X positivity at baseline (49% vs 29%; positive vs negative, P=0.033) and 12months (52% vs 31%, P=0.04). Patients positive (n=28) for all four antibacterial antibodies (anti-CBir1, anti-OmpC, anti-A4-Fla2, and anti-Fla-X) at baseline were more likely to experience recurrence at 18months than patients negative (n=32) for all four antibodies (82% vs 18%, P=0.034; odds ratio 6.4, 95% confidence interval 1.16-34.9). The baseline quartile sum score for all six antimicrobial antibodies was higher in patients with severe recurrence (Rutgeert's i3-i4) at 18months, adjusted for clinical risk factors (odds ratio 1.16, 95% confidence interval 1.01-1.34, P=0.039). Smoking affected antibody status. Anti-Fla-X and presence of all anti-bacterial antibodies identifies patients at higher risk of early postoperative Crohn's disease recurrence. Serologic screening pre-operatively may help identify patients at increased risk of recurrence.