PoM No 1, 2014

Publication of the Month

 

January 01/14: A Detailed Analysis of Possible Predictors of Complications in Crohn’s Disease 

 

Key messages:

  • ASCA IgG is the most important marker in serological panels for assessing prognosis in Crohn’s Disease
  • Other assessed CD-associated risk variants (genetic, phenotypic, serological and psychological) do not seem to add value as predictors of CD prognosis  

 

Ryan JD, Sliverberg MS, Xu W, Graff LA, Targownik LE, Walker JR, Carr R, Clara I, Miller N, Rogala L, Bernstein CN
Predicting complicated Crohn’s disease and surgery: phenotypes, genetics, serology and psychological characteristics of a population-based cohort
Aliment. Pharmacol. Ther. 2013; 38: 274-283  

 

Background: Crohn’s disease (CD) is a relapsing/remitting inflammatory disease of unknown cause which may affect any part of the gastrointestinal tract. In many patients, it progresses to complications including strictures, abscesses and fistulas that may result in surgery. CD can be phenotypically defined based on distinct clinical patterns of disease (Montreal classification) but this system has not been able to identify individuals at risk of CD complications where early, aggressive intervention may be of benefit.  

 

Summary: The Manitoba IBD Cohort is a population-based sample of adults tracked prospectively via surveys, clinical interviews and blood draws in order to identify determinants of IBD outcomes. For this study, 388 participated (established as having excellent representativeness of the provincial IBD population) and 182 had CD of whom paired sera from T1 (within 3 years of diagnosis) and T2 (a median of 9.3 years from diagnosis) was available for 127. Association analyses were applied to detect the associations among several single nucleotide polymorphisms (SNPs) known to be connected to CD, serological markers, psychological variables, phenotype and surgical endpoints.

 

Conclusions: Anti-Saccharomyces cerevisiae antibody (ASCA) IgG was the only significant predictor (OR =3.01) for stricturing or penetrating disease (itself a predictor for surgery). Sex, age at diagnosis, perianal disease, family history, adherence to medications and all other psychological traits were not correlated with complicated disease. Surgery was associated with ASCA IgA and IgG at both time points and weakly associated with the NOD2 rs2066847 SNP although ASCA andNOD2 may not be independent. There was also a trend of association between surgery and higher childhood adversity scores.  

 

Comment: The strength of this study lies in the fact that it is population-based and also able to look at many variables over an extended time period. In a disease group where more than half of subjects will experience a significant complication from their disease within 9 years from diagnosis, ASCA IgG testing can not only discriminate CD from ulcerative colitis but will also improve prognostication.

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As in all diagnostic testing, the diagnosis is made by the physican based on both test results and the patient history.