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.
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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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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