BACKGROUND & AIMS: Some patients diagnosed with UC undergo a change in diagnosis to CD. Identification of predictors of a diagnostic change could potentially impact the management of patients with colonic inflammation. Our aim was to characterize clinical and serologic predictors of a change in diagnosis from UC to CD. METHODS: A nested, case-controlled study was performed to compare individuals with a change in diagnosis from UC to CD (cases) with age-matched UC and CD controls; primary analysis compared cases with UC controls. Subjects underwent chart review for clinical "red flags" identified by gastroenterologists with expertise in IBD. Serum collected at the time of database enrollment was tested for antibodies to oligomannan (anti-Saccharomyces cerevisiae), Pseudomonas fluorescens-related protein, Escherichia coli outer membrane porin C, CBir1 flagellin, and perinuclear antineutrophil cytoplasmic antibodies. RESULTS: Twenty-one cases, 52 UC controls, and 56 CD controls were assessed. Three red flags, but no serologic markers, differed between cases and UC controls. At initial colonoscopy, cases were more likely to have extensive colonic involvement than UC controls (P = .008). Multivariate regression identified non-bloody diarrhea at initial presentation (P = .01) and weight loss >10% at presentation (P = .007) as independent predictors of diagnostic change. Serologic markers did not add to the contribution of these 2 clinical factors in predicting a change in diagnosis from UC to CD. Diagnostic change was evident in 6 of 6 (100%) patients with both predictors, compared with 8 of 50 (16%) with neither of these factors (P < .0001). CONCLUSIONS: Patients with a diagnosis of UC with initial non-bloody diarrhea or weight loss have an increased likelihood of subsequent change in diagnosis to CD and might thus warrant further diagnostic work-up.
BACKGROUND & AIMS: Some patients diagnosed with UC undergo a change in diagnosis to CD. Identification of predictors of a diagnostic change could potentially impact the management of patients with colonic inflammation. Our aim was to characterize clinical and serologic predictors of a change in diagnosis from UC to CD. METHODS: A nested, case-controlled study was performed to compare individuals with a change in diagnosis from UC to CD (cases) with age-matched UC and CD controls; primary analysis compared cases with UC controls. Subjects underwent chart review for clinical "red flags" identified by gastroenterologists with expertise in IBD. Serum collected at the time of database enrollment was tested for antibodies to oligomannan (anti-Saccharomyces cerevisiae), Pseudomonas fluorescens-related protein, Escherichia coli outer membrane porin C, CBir1 flagellin, and perinuclear antineutrophil cytoplasmic antibodies. RESULTS: Twenty-one cases, 52 UC controls, and 56 CD controls were assessed. Three red flags, but no serologic markers, differed between cases and UC controls. At initial colonoscopy, cases were more likely to have extensive colonic involvement than UC controls (P = .008). Multivariate regression identified non-bloody diarrhea at initial presentation (P = .01) and weight loss >10% at presentation (P = .007) as independent predictors of diagnostic change. Serologic markers did not add to the contribution of these 2 clinical factors in predicting a change in diagnosis from UC to CD. Diagnostic change was evident in 6 of 6 (100%) patients with both predictors, compared with 8 of 50 (16%) with neither of these factors (P < .0001). CONCLUSIONS:Patients with a diagnosis of UC with initial non-bloody diarrhea or weight loss have an increased likelihood of subsequent change in diagnosis to CD and might thus warrant further diagnostic work-up.
Authors: Peter Townsend; Qibin Zhang; Jason Shapiro; Bobbie-Jo Webb-Robertson; Lisa Bramer; Athena A Schepmoes; Karl K Weitz; Meaghan Mallette; Heather Moniz; Renee Bright; Marjorie Merrick; Samir A Shah; Bruce E Sands; Neal Leleiko Journal: Inflamm Bowel Dis Date: 2015-08 Impact factor: 5.325
Authors: Gian Eugenio Tontini; Maurizio Vecchi; Luca Pastorelli; Markus F Neurath; Helmut Neumann Journal: World J Gastroenterol Date: 2015-01-07 Impact factor: 5.742
Authors: Brennan M R Spiegel; Wayne Ho; Eric Esrailian; Stephan Targan; Peter D R Higgins; Corey A Siegel; Marla Dubinsky; Gil Y Melmed Journal: Clin Gastroenterol Hepatol Date: 2008-09-04 Impact factor: 11.382
Authors: Sara Ashorn; Teemu Honkanen; Kaija-Leena Kolho; Merja Ashorn; Tuuli Välineva; Bo Wei; Jonathan Braun; Immo Rantala; Tiina Luukkaala; Sari Iltanen Journal: Inflamm Bowel Dis Date: 2009-02 Impact factor: 5.325
Authors: Gil Y Melmed; Phillip R Fleshner; Ovunc Bardakcioglu; Andrew Ippoliti; Eric A Vasiliauskas; Konstantinos A Papadakis; Marla Dubinsky; Carol Landers; Jerome I Rotter; Stephan R Targan Journal: Dis Colon Rectum Date: 2007-12-18 Impact factor: 4.585