Inflammatory Bowel Disease (IBD) Expanded Profile

CPT: 83516(x3); 86255; 86671
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Test Details

Synonyms

  • Atypical pANCA
  • Glycominds
  • IBDX

Test Includes

Antichitobioside carbohydrate antibodies (ACCA); antilaminaribioside carbohydrate antibodies (ALCA); antimannobioside carbohydrate antibodies (AMCA); anti-Saccharomyces cerevisiae antibodies (gASCA); atypical perinuclear antineutrophil cytoplasmic antibody (pANCA).

Use

Aids in the diagnosis of inflammatory bowel disease (IBD) and the differential diagnosis of Crohn's disease (CD) and ulcerative colitis (UC); prognostic aid for clinical management of patients with CD.

Limitations

Results of this panel should be used in conjunction with clinical findings and other laboratory tests.

Methodology

Enzyme immunoassay (EIA) for ACCA, ALCA, AMCA, gASCA; indirect fluorescent antibody (IFA) for atypical pANCA

Reference Interval

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."

Additional Information

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). Its prevalence in the adult population approaches 0.3%.1 The differential diagnosis of the different forms of IBD is often difficult, time-consuming, and invasive.2 The gold standard for diagnosis is endoscopy with biopsies for histologic examination.3 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 CD, while pANCA positivity is found predominantly in patients with UC.2 A combination of ASCA and pANCA has a specificity of as high as 99% for differentiation of CD from UC.3 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.3

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.4

This profile 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.3-6

The antibodies included in the panel are ASCA (anti-Saccharomyces cerevisiae antibodies), ALCA (antilaminaribioside carbohydrate antibodies), ACCA (antichitobioside carbohydrate antibodies), and AMCA (antimannobioside carbohydrate antibodies).3,5,6 Numerous studies of CD have demonstrated an association between ileal disease and the presence of ACCA,3 ALCA,3,6 AMCA,6 and ASCA.3,5-10 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.3,5,6,9,11 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,3,5 ALCA,3,5,6 AMCA,3,5 and ASCA.3,5,6,8-10 Among these antibodies, the association with complicated disease behavior or surgery increased with the number and concentration of antibodies.3,5,9,11

Specimen Requirements

Specimen

Serum

Volume

1 mL

Minimum Volume

0.5 mL

Container

Red-top tube or gel-barrier tube

Storage Instructions

Refrigerate

Causes for Rejection

Hemolysis; lipemia; heat-treated specimen; gross bacterial contamination

Clinical Information

Footnotes

1. Carter M, Lobo AJ, Travis SP; IBD Section, British Society of Gastroenterology. Guidelines for the management of inflammatory bowel disease in adults. Gut. 2004; 53(Suppl 5):V1-16.15306569
2. Jaskowski TD, Litwin CM, Hill HR. Analysis of serum antibodies in patients suspected of having inflammatory bowel disease. Clin Vaccine Immunol. 2006; 13(6):655-660. 16760323
3. Ferrante M, Henckaerts L, Joossens M, et al. New serological markers in inflammatory bowel disease are associated with complicated disease behavior. Gut. 2007; 56(10):1394-1403.17456509
4. Rieder F, Schleder S, Wolf A, et al. Serum anti-glycan antibodies predict complicated Crohn's disease behavior: A cohort study. Inflamm Bowel Dis. 2010; 16(8):1367-1375.
5. Papp M, Altorjay I, Dotan N, et al. New serological markers for inflammatory bowel disease are associated with earlier age at onset, complicated disease behavior, risk for surgery, and NOD2/CARD15 genotype in a Hungarian IBD cohort. Am J Gastroenterol. 2008; 103(3):665-681.17478404
6. Dotan I, Fishman S, Dgani Y, et al. Antibodies against laminaribioside and chitobioside are novel serologic markers in Crohn's disease. Gastroenterology. 2006; 131(2):366-378.16890590
7. Vasiliauskas EA, Plevy SE, Landers CJ, et al. Perinuclear antineutrophil cytoplasmic antibodies in patients with Crohn's disease define a clinical subgroup. Gastroenterology. 1996; 110(6):1810-1819.8964407
8. Vasiliauskas EA, Kam LY, Karp LC, et al. Marker antibody expression stratifies Crohn's disease into immunologically homogeneous subgroups with distinct clinical characteristics. Gut. 2000; 47(4):487-496.10986208
9. Arnott ID, Landers CJ, Nimmo EJ, et al. Sero-reactivity to microbial components in Crohn's disease Is associated with disease severity and progression, but not NOD2/CARD15 genotype. Am J Gastroenterol. 2004; 99(12):2376-2384.15571586
10. Walker LJ, Aldhous MC, Drummond HE, et al. Anti-Saccharomyces cerevisiae antibodies (ASCA), in Crohn's disease are associated with disease severity but not NOD2/CARD15 mutations. Clin Exp Immuno. 2004; 135(3):490-496.15008984
11. Mow WS, Vasiliauskas EA, Lin YC, et al. Association of antibody responses to microbial antigens and complications of small bowel Crohn's disease. Gastroenterology. 2004; 126(2):414-424.14762777

LOINC® Map

Order Code Order Code Name Order Loinc Result Code Result Code Name UofM Result LOINC
162045 IBD Expanded Panel 162033 gASCA units 47321-5
162045 IBD Expanded Panel 162034 ACCA units 53594-8
162045 IBD Expanded Panel 162035 ALCA units 53596-3
162045 IBD Expanded Panel 162029 AMCA units 53597-1
162045 IBD Expanded Panel 162026 Atypical pANCA 53029-5
162045 IBD Expanded Panel 162030 Comments N/A

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