Abstract
The diagnosis of inflammatory bowel disease (IBD) is based on a combination of clinical, endoscopic, histological, radiological and laboratory methods. However, conventional diagnostic methods are not always sufficiently informative in IBD, especially in the case of unclassified colitis, which necessitates the extension of standard diagnostic approaches. Currently, there is an actively search for non-invasive serological markers for early and differential diagnosis of IBD and for the assessment of activity and prognosis of Crohn's disease (CD) and ulcerative colitis (UC). Among the most interesting serological markers are anti-Saccharomyces cerevisiae antibodies (ASCA), anti-neutrophil cytoplasmic antibodies (ANCA), goblet cells antibodies (GAB) and pancreatic autoantibodies (PAB). The aim of this review is to assess the diagnostic and prognostic significance of ASCA, ANCA, GAB, PAB in CD and UC. The paper presents the summary of the data on the role of ASCA, ANCA, GAB and PAB in abnormalities of the immunological tolerance mechanisms to intestinal microflora and intestinal permeability in IBD. We discuss the results of the studies on the associations of ASCA with a complicated CD phenotype, its response to genetically engineered biological therapies, and the need for surgical intervention. The article describes the data on the association of ANCA to the risk of progression of left-sided UC to widespread (total) colon lesions resistant to hormonal therapy, and that of antibodies to DNA-lactoferrin complexes and proteinase 3 to primary sclerosing cholangitis. It has been noted that PAB may be a prognostic marker for ileocolitis, perianal lesions, extraintestinal manifestations and complicated CD, and GAB a predictor of total UC with chronic persistent course. It should be emphasized that combined determination of ASCA, ANCA, GAB and PAB is highly informative, compared to the isolated detection of autoantibodies, for the differential diagnosis and prognosis of CD and UC.
Highlights
Диагностика воспалительных заболеваний кишечника (ВЗК) основана на комбинации клинических, эндоскопических, гистологических, лучевых и лабораторных методов исследования
Остается нерешенным практический вопрос – как наиболее эффективно применять эти серологические маркеры для ранней и дифференциальной диагностики, а также индивидуального долгосрочного прогнозирования клинических исходов болезни Крона (БК) и язвенного колита (ЯК)
All the authors made their significant contributions to the research and preparation of the article, have read and approved the final version before submission
Summary
Антитела к S. cerevisiae (ASCA) классов IgA и IgG относятся к семейству антигликановых антител. У серопозитивных по ASCA классов IgA и/или IgG пациентов с БК отмечался ранний (до 40 лет) дебют, прогрессирующее течение, поражение подвздошной кишки и развитие осложненных (пенетрирующая и стенозирующая) форм заболевания [25,26,27]. Положительные по ASCA класса IgG, в 83,9% случаев имели илеит, в 61,1% – илеоколит и в 50% – локализацию БК в верхних отделах ЖКТ (p < 0,05) [28, 29], тогда как при классе IgA в 45,3% случаев регистрировались перианальные поражения (p < 0,001) [28]. Вместе с тем обнаружение ASCA, особенно класса IgA, служило независимым предиктором необходимости проведения хирургического лечения в течение 5 лет после установления диагноза и послеоперационного рецидива БК [13, 23, 33]
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