Serological antibodies and surgery in a population-based inception cohort of Crohn’s disease patients – the IBSEN study

Abstract

Introduction: Serological antibodies have been associated with complicated disease course in Crohn’s disease (CD), including the need for surgery.

Aim: The aim of this study was to investigate if a panel of relevant antibodies could predict surgery in a prospective population-based cohort of patients with CD.

Methods: The population-based IBSEN cohort has been followed prospectively for 20 years. At the 10- and 20-year follow-up, the following panel of serological antibodies was analysed: pANCA, ASCA IgA, ASCA IgG, anti-OmpC, anti-I2, and anti-CBir1. At the 20-year follow-up or until lost to follow-up, all CD-related surgeries were registered.

Results: Serum was available from 159 patients at 10-year follow-up and 135 patients at 20-year follow-up. In 113 patients, serum was available at both time points. No significant change of antibody status (positive vs. negative) was found from 10-year to 20-year follow-up. Negative pANCA, positive ASCA IgA and positive ASCA IgG at 10-year follow-up were all individually associated with increased risk for CD-related surgery. There was no association between anti-OmpC, anti-I2 or anti-CBir1 and CD-related surgery. In a multiple regression model including disease location and behaviour, only stricturing or penetrating disease behaviour and negative pANCA remained significantly associated with higher odds for surgery.

Conclusion: Positive ASCA IgA and IgG, and negative pANCA were associated with higher odds for CD-related surgery in univariate analysis. Since disease phenotype changes during the disease course, while serological antibodies are stable, our results support the use of pANCA, ASCA IgA and ASCA IgG as prognostic markers in CD.

Keywords:

• Biomarkers
• Crohn’s disease
• epidemiology
• inflammatory bowel disease
• serological antibody
• serological marker
• surgery

Acknowledgements

The authors wish to thank Prometheus Laboratories Inc. for performing laboratory analyses free of charge. We are grateful for valuable comments from Stephan Targan, Cedars-Sinai, Los Angeles CA. We also wish to acknowledge all the members of the IBSEN study group, for collection of data generating IBD research for more than 20 years.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

VAK has received a postdoctoral grant from the South Eastern Health Region of Norway.