John B. Kisiel

Anti-Saccharomyces cerevisiae antibody (ASCA) positivity is associated with increased risk for early surgery in Crohn’s disease

Background: Anti-Saccharomyces cerevisiae antibodies (ASCA) are a specific but only moderately sensitive diagnostic marker for Crohn’s disease. We sought to explore the role of ASCA as a prognostic marker for aggressive disease phenotype in Crohn’s disease. Aims: To determine the role of ASCA status as a risk factor for early surgery in Crohn’s disease. Subjects: We performed a case control study in a cohort of patients, newly diagnosed with Crohn’s disease, between 1991 and 1999. All patients were followed for at least three years. Case subjects (nu200a=u200a35) included those who had major surgery for Crohn’s disease within three years of diagnosis. Controls (nu200a=u200a35) included patients matched to cases for age, sex, disease location, and smoking status, and who did not undergo major surgery for Crohn’s disease within three years of diagnosis. Methods: Blinded assays were performed on serum for ASCA (immunoglobulin (Ig)A and IgG). A paired analysis of cases-controls was performed to test for the association between ASCA status and risk of early surgery. Results: ASCA IgA was strongly associated with early surgery (odds ratio (OR) 8.5 (95% confidence interval (CI) 2.0–75.9); pu200a=u200a0.0013). ASCA IgG+ and ASCA IgG+/IgA+ patients were also at increased risk for early surgery (OR 5.5 (95% CI 1.2–51.1), pu200a=u200a0.0265; and OR 5.0 (95% CI 1.1–46.9), pu200a=u200a0.0433, respectively). The association between ASCA and early surgery was evident in patients requiring surgery for ileal or ileocolonic disease. Conclusions: Patients with Crohn’s disease who are positive for ASCA IgA, IgG, or both, may define a subset of patients with Crohn’s disease at increased risk for early surgery.

Identification of prognostic phenotypes of esophageal adenocarcinoma in two independent cohorts

BACKGROUND & AIMSnMost patients with esophageal adenocarcinoma (EAC) present with de novo tumors. Although this could be due to inadequate screening strategies, the precise reason for this observation is not clear. We compared survival of patients with prevalent EAC with and without synchronous Barrett esophagus (BE) with intestinal metaplasia (IM) at the time of EAC diagnosis.nnnMETHODSnClinical data were studied using Cox proportional hazards regression to evaluate the effect of synchronous BE-IM on EAC survival independent of age, sex, TNM stage, and tumor location. Wexa0analyzed data from a cohort of patients with EAC from the Mayo Clinic (n=411; 203 with BE and IM) and a multicenter cohort from the United Kingdom (n=1417; 638 with BE and IM).nnnRESULTSnIn the Mayo cohort, BE with IM had a reduced risk of death compared to patients without BE and IM (hazard ratio [HR] 0.44; 95% CI, 0.34-0.57; P<.001). In a multivariable analysis, BE with IM was associated with longerxa0survival independent of patient age or sex, tumor stage or location, and BE length (adjusted HR, 0.66; 95% CI, 0.5-0.88; P=.005). In the United Kingdom cohort, patients BE and IM had a reduced risk of death compared with those without (HR, 0.59; 95% CI, 0.5-0.69; P<.001), with continued significance in multivariable analysis that included patient age and sex and tumor stage and tumor location (adjusted HR, 0.77; 95% CI, 0.64-0.93; P=.006).nnnCONCLUSIONnTwo types of EAC can be characterized based on the presence or absence of BE. These findings could increase our understanding the etiology of EAC, and be used in management and prognosis ofxa0patients.

Clarity and caution in the natural history of low-grade dysplasia in ulcerative colitis.

Abstract: A substantial body of evidence supports the safety of conservative endoscopic polypectomy for discrete, adenomatous-appearing colonic polyps in patients with ulcerative colitis (UC). Much less is known about the clinicopathologic factors of low-grade dysplastic lesions at risk for subsequent high-grade dysplasia or colorectal cancer. In this issue of the American Journal of Gastroenterology, Choi et al. examine the outcome of patients with low-grade dysplasia participating in a surveillance cohort at St Mark’s Hospital, one of the oldest and largest programs of its kind. Long-term follow-up of many, well-phenotyped, low-grade dysplasia cases sheds new light, and raises new questions, on our UC surveillance practice.

ASCA positivity is associated with increased risk for early surgery in Crohn's disease

Purpose: Serum markers have been used as tools in the diagnosis of inflammatory bowel diseases (Crohns disease and ulcerative colitis) including anti-Saccharomyces cerevisiae antibodies (ASCA), neutrophil-specific nuclear autoantibodies (pANCA), and antibodies to outer membrane protein C of Escherichia coli (OmpC). It has been suggested that ASCA status correlates with aggressive phenotype in Crohns disease (CD) including early age of onset, fibrostenosis, and internal fistulae. We performed a case-control study to evaluate the role of ASCA as a risk factor for early surgery in CD.