New serological markers in pediatric patients with inflammatory bowel disease

Abstract

The spectrum of serological markers associated with inflammatory bowel disease (IBD) is rapidly growing. Due to frequently delayed or missed diagnoses, the application of non-invasive diagnostic tests for IBD, as well as differentiation between ulcerative colitis (UC) and Crohn’s disease (CD), would be useful in the pediatric population. In addition, the combination of pancreatic autoantibodies and antibodies against Saccharomyces cerevisiae antibodies/perinuclear cytoplasmic antibody (pANCA) improved the sensitivity of serological markers in pediatric patients with CD and UC. Some studies suggested that age-associated differences in the patterns of antibodies may be present, particularly in the youngest children. In CD, most patients develop stricturing or perforating complications, and a significant number of patients undergo surgery during the disease course. Based on recent knowledge, serum antibodies are qualitatively and quantitatively associated with complicated CD behavior and CD-related surgery. Pediatric UC is characterized by extensive colitis and a high rate of colectomy. In patients with UC, high levels of anti-CBir1 and pANCA are associated with the development of pouchitis after ileal pouch-anal anastomosis. Thus, serologic markers for IBD can be applied to stratify IBD patients into more homogeneous subgroups with respect to disease progression. In conclusion, identification of patients at an increased risk of rapid disease progression is of great interest, as the application of early and more aggressive pharmaceutical intervention could have the potential to alter the natural history of IBD, and reduce complications and hospitalizations.

Keywords: Inflammatory bowel disease; Crohn’s disease; Ulcerative colitis; Pediatric; Serologic markers; Antimicrobial antibodies; Anti-glycan antibodies; Pancreatic antibodies; Inflammatory bowel disease

Core tip: Application of non-invasive diagnostic tests for the diagnosis of inflammatory bowel disease (IBD) and differentiation between ulcerative colitis (UC) and Crohn’s disease (CD) would be useful in the pediatric population. The combination of pancreatic autoantibodies and antibodies against Saccharomyces cerevisiae antibodies/perinuclear cytoplasmic antibody improved the sensitivity of serological markers in pediatric patients with CD and UC. In addition, serologic markers for IBD can be applied to stratify IBD patients into more homogeneous subgroups with respect to disease progression. With this knowledge, clinicians will be able to stratify patients accordingly with regards to the risk of disease progression, create a personalized treatment strategy, and attempt to modify disease course, thereby improving long-term prognosis.