This marker is usually part of a test called IBD Expanded Panel (IBD = Inflammatory Bowel Disease) and aids in the diagnosis of inflammatory bowel disease and the differential diagnosis of Crohn’s disease (CD) and ulcerative colitis (UC); it is also a prognostic aid for clinical management of patients with CD.
What is IBD?
Inflammatory bowel disease is a chronic disorder of the lower gastrointestinal tract that may occur in three forms:
- Crohn’s disease (CD),
- Ulcerative colitis (UC),
- and Indeterminate colitis (IC).
How to diagnose IBD?
Its prevalence in the adult population approaches 0.3%. The differential diagnosis of the different forms of IBD is often difficult, time-consuming, and invasive. The gold standard for diagnosis is endoscopy with biopsies for histologic examination.
In recent years, however, a number of serological markers have been introduced. The most commonly employed serological markers of IBD are:
- anti-Saccharomyces cerevisiae antibody (ASCA) and
- atypical perinuclear antineutrophil cytoplasmic antibody (pANCA).
ASCA positivity is found predominantly in patients with Crohn’s disease (CD), while pANCA positivity is found predominantly in patients with Ulcerative colitis (UC).
A combination of ASCA and pANCA has a specificity of as high as 99% for differentiation of CD from UC. Nevertheless, there are a substantial number of patients with IBD who are negative for both. The addition of novel serological markers improves the sensitivity of the conventional ASCA/pANCA combination.
About two-thirds of patients with CD develop either a stricturing or penetrating disease course within 10 years after diagnosis. As many as 80% of all CD patients undergo surgery at least once during the course of their disease. Consequently, the identification of individuals susceptible to the development of more complicated disease behavior would allow for earlier and more aggressive treatment.
The IBD Expanded Panel test offers three novel markers:
- antichitobioside IgA (ACCA),
- antilaminaribioside IgG (ALCA),
- antimannobioside IgG (AMCA),
together with anti-Saccharomyces cerevisiae IgG (gASCA) and pANCA.
These markers provide additional diagnostic and prognostic information depending on the combination of results.
The antibodies included in the panel are:
- ASCA (anti-Saccharomyces cerevisiae antibodies),
- ALCA (antilaminaribioside carbohydrate antibodies),
- ACCA (antichitobioside carbohydrate antibodies),
- AMCA (antimannobioside carbohydrate antibodies).
Numerous studies of CD have demonstrated an association between ileal disease (ileal = last part of the small intestine) and the presence of ACCA, ALCA, AMCA, and ASCA. Among these antibodies, the association with localization to the small intestine increased with the number of positive antibodies and with the concentration of individual antibodies. A more aggressive or complicated disease course in CD (as indicated by stricturing or perforation of the intestine or need for surgery), has also been associated with the presence of ACCA, ALCA, AMCA, and ASCA. Among these antibodies, the association with complicated disease behavior or surgery increased with the number and concentration of antibodies.
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How to interpret your results:
###Please look at all markers of this report together###
When the only positive marker is pANCA, the interpretive comment on the report will read: "Suggestive of ulcerative colitis."
When only one of ACCA, ALCA, AMCA, or gASCA is positive and pANCA is negative, the interpretive comment will read: "Suggestive of Crohn's disease. Pattern is not conclusive for disease behavior risk stratification."
When only one of ACCA, ALCA, AMCA, or gASCA is positive and pANCA is positive, the interpretive comment will read: "Suggestive of inflammatory bowel disease. Pattern is not conclusive for any specific disease form."
When any two of ACCA, ALCA, AMCA, or gASCA are positive and pANCA is positive or negative, the interpretive comment will read: "Suggestive of Crohn's disease with high risk of aggressive disease behavior (development of strictures or fistulae)."
When any three or more of ACCA, ALCA, AMCA, or gASCA are positive and pANCA is positive or negative, the interpretive comment will read: "Suggestive of Crohn's disease with the very high risk of aggressive disease behavior (development of strictures or fistulae)."
When all markers are negative, the interpretive comment on the report will read: "Pattern is not suggestive of inflammatory bowel disease."
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Numerous studies of CD have demonstrated an association between ileal disease (ileal = last part of the small intestine) and the presence of ACCA, ALCA, AMCA, and ASCA. Among these antibodies, the association with localization to the small intestine increased with the number of positive antibodies and with the concentration of individual antibodies. A more aggressive or complicated disease course in CD (as indicated by stricturing or perforation of the intestine or need for surgery), has also been associated with the presence of ACCA, ALCA, AMCA, and ASCA. Among these antibodies, the association with complicated disease behavior or surgery increased with the number and concentration of antibodies.
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If gASCA levels are elevated in an IBD Expanded Panel, it may suggest a greater likelihood of Crohn's Disease. However, the presence of ASCA alone is not definitive for diagnosing Crohn's Disease. It's usually considered alongside other clinical findings, symptoms, and test results.
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More about Crohn's Disease:
Crohn's disease is a chronic inflammatory bowel disease (IBD) characterized by inflammation of the gastrointestinal (GI) tract. It can affect any part of the GI tract from the mouth to the anus, but most commonly it affects the end of the small intestine and the beginning of the large intestine. Symptoms can vary but often include abdominal pain, diarrhea, fatigue, weight loss, and malnutrition. The exact cause of Crohn's disease is unknown, but it is believed to result from an interaction of genetic, environmental, and immune factors. The inflammation caused by Crohn's disease can be painful and debilitating, and may lead to life-threatening complications. While there is no cure, treatments are available that can greatly reduce the symptoms and even bring about long-term remission. These treatments include medication, lifestyle changes, and sometimes surgery. Management of the disease requires a comprehensive approach and is often tailored to the individual patient's needs.
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It's important to understand that elevated gASCA levels are a biomarker and not a direct cause of symptoms or disease. Therefore, the treatment focuses on managing Crohn's disease itself rather than specifically targeting the elevated gASCA levels. Here are general approaches to treating Crohn's disease:
Medication:
Diet and Nutrition Management:
Lifestyle Changes:
Surgery:
Regular Monitoring:
Remember, treatment for Crohn's disease is highly individualized and depends on the severity and location of the disease, as well as the patient's overall health and response to treatment. It's crucial to work closely with a gastroenterologist to develop a tailored treatment plan. Additionally, ongoing research may continue to provide new insights and treatments for Crohn's disease, so staying informed about the latest developments is beneficial.
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How to interpret your results:
###Please look at all markers of this report together###
When the only positive marker is pANCA, the interpretive comment on the report will read: "Suggestive of ulcerative colitis."
When only one of ACCA, ALCA, AMCA, or gASCA is positive and pANCA is negative, the interpretive comment will read: "Suggestive of Crohn's disease. Pattern is not conclusive for disease behavior risk stratification."
When only one of ACCA, ALCA, AMCA, or gASCA is positive and pANCA is positive, the interpretive comment will read: "Suggestive of inflammatory bowel disease. Pattern is not conclusive for any specific disease form."
When any two of ACCA, ALCA, AMCA, or gASCA are positive and pANCA is positive or negative, the interpretive comment will read: "Suggestive of Crohn's disease with high risk of aggressive disease behavior (development of strictures or fistulae)."
When any three or more of ACCA, ALCA, AMCA, or gASCA are positive and pANCA is positive or negative, the interpretive comment will read: "Suggestive of Crohn's disease with the very high risk of aggressive disease behavior (development of strictures or fistulae)."
When all markers are negative, the interpretive comment on the report will read: "Pattern is not suggestive of inflammatory bowel disease."
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If you are still determining whether Healthmatters support your lab results, the rule is that if you can test it, you can upload it to Healthmatters.
While we do talk about popular labs, we welcome reports from lots of other places too. It's as simple as this: if you can get a test done, you can upload it to Healthmatters. We can interpret results from any lab out there. If laboratories can analyze it, we can interpret it.
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There are two ways to add your test reports to your healthmatters.io account. One option is to input the data using the data entry forms. The other method is to utilize our "Data entry service."
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1. Graph View:Dive into a visual journey with our biomarker graphs, showcasing over 40 data points. Combining years of results unveils trends, empowering you to make informed decisions. Our visualization tools make it a breeze to compare and understand changes over time, even if your results are from different labs. A search function and filters simplify the exploration of extensive data, allowing you to focus on what needs attention.
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3. Table View:For a holistic view of all biomarkers side by side, our table view is your go-to. Results are neatly displayed in a categorized and dated table, ideal for those with an extensive test history. Utilize sorting, filters, and color-coding to enhance your analysis and gain extra insights.
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