Crohns Disease Blood Tests

Crohns Disease Blood Tests

Crohns Disease Blood Tests

A relatively new and exciting development that has added significantly to the screening, diagnosis, and management of ulcerative colitis and Crohn’s disease. Differentiating the two may allow better predictions regarding responses to medical treatments, decisions regarding surgery options and the risks of various complications.

Antibodies to various proteins including Baker’s or Brewer’s yeast (Saccharomyces cerevisiae) and bacteria like Escherichia. Coli (E. coli) are present in the blood of many people with Crohn’s disease but rarely in healthy people.

Antibodies to a normal cell component, a nuclear protein, is present in most people with ulcerative colitis, a few people with Crohn’s whose colitis behaves more like ulcerative colitis than Crohn’s, and rarely in normal people.

Antibody tests

Serologic markers are blood tests looking for markers of diseases. The serologic markers or antibody tests for ulcerative colitis and Crohn’s disease are pANCA and ASCA, OmpC, and CBir1 Flagellin respectively. The latter three blood tests for Crohn’s are only available through one laboratory, Prometheus Laboratories, Inc.

Ulcerative colitis is a chronic inflammatory bowel disease (IBD) of unknown cause that only involves the colon.

It affects the superficial lining of the colon and rarely causes bowel obstruction (blockage) or perforation (rupture) but frequently causes severe bloody diarrhea, blood in the stool, weight loss, abdominal pain, as well as joint aches or arthritis, skin rashes, eye irritation and occasionally a severe liver disorder known as primary sclerosing cholangitis that can lead to cirrhosis and liver cancer. Ulcerative colitis can be cured by complete removal of the colon but not Crohn’s disease.

Crohn’s disease can also cause colitis

However usually also affects the very end of the small intestine called the ileum (ileitis or regional enteritis).

When Crohn’s affects only the colon it may be difficult to distinguish it from ulcerative colitis through Crohn’s tends to change the colon in a patchy manner whereas ulcerative colitis is continuous.

Crohn’s can affect the gastrointestinal tract anywhere from the mouth to the anus and is not curable by removing the colon.

It is also frequently associated with bowel strictures (constrictions) causing an obstruction that may require surgery. It also may be associated with fistula that is abnormal connections of the intestine to other organs and the skin or it can result in abscesses or perforation requiring surgery It is important to distinguish Crohn’s disease from ulcerative colitis since medical treatments and surgical approaches may differ and the types of complications that can occur can be much different.

Traditionally, the diagnosis of ulcerative colitis and Crohn’s disease

Highly accurate by the appearance of the colon on colonoscopy or x-rays that confirm the presence or absence of involvement of other parts of the intestinal tract. Diagnosis is confirmed by a typical pattern of inflammation of the intestine lining as seen under the microscope on tissue obtained by biopsy during colonoscopy.

However, before blood tests were available about 10% of people with IBD were diagnosed as having an indeterminate colitis because the biopsies could not distinguish between the ulcerative colitis and Crohn’s disease.

The blood tests currently available

Crohns Disease Blood Tests

Crohns Disease Blood Tests

Are pANCA, anti-ASCA, anti-OmpC, and anti-CBir1 antibody antibodies. pANCA is the peripheral anti-nuclear antibody. It is an abnormal antibody to nuclear protein of cells and is highly sensitive and specific for ulcerative colitis.

The pANCA beneficial has been further divided into subsets by Prometheus Laboratories Inc.

Neutrophil-specific pANCA ELISA (NSNA) is positive in the majority of people with ulcerative colitis (UC) and a small subset of people with Crohn’s disease that have disease characteristics more like UC.

Immunofluorescent cellular staining of neutrophils (NSNA IFA) and enzyme DNase testing (NSNA DNase sensitivity) is also done as part of the Prometheus IBD Serology 7.

The latter test when present in high levels is significantly associated with the development of inflammation of the rectal pouch (pouchitis) created when someone has their entire colon removed for ulcerative colitis that does not respond to medical treatment.

ASCA is anti-saccharomyces cerevisiae antibody.

Saccharomyces cerevisiae is Brewer’s or Baker’s yeast.

Crohn’s patients have a high prevalence of abnormal antibodies to this yeast. Some have suggested that another yeast, Candida albicans, somehow plays a role in this abnormal response.

A few people with celiac disease have this antibody present in their blood in the absence of signs of Crohn’s disease. OmpC is the abbreviation for an antibody that develops in many Crohn’s patients to the outer membrane porin protein of the bacteria E. coli though that bacteria is not thought to be the cause of Crohn’s disease.

Just recently Prometheus Laboratories added antibody testing for a specific protein on bacteria that constitutes the hair-like or hair-like structure on certain bacteria enabling movement and attachment of bacteria in the intestine called CBir1 flagellin.

Future blood tests may include antibodies

against specific sugar (mannose) residues in the cell wall of the yeast Saccharomyces cerevisiae.

Anti- and anti-antibodies were recently reported to be present in Crohn’s patients who were anti-ASCA negative possibly further strengthening the ability to distinguish them from people with ulcerative colitis.

This is also interesting because of suspicions and the lay public interest in the role of sugars or glycans and yeast in IBD.

In particular the reports in the lay literature of success of carbohydrate-specific diet in IBD.

If you have a diagnosis of ulcerative colitis or Crohn’s disease

These blood tests may be beneficial in your treatment. If you have unexplained abdominal pain, diarrhea, or blood in your stools, then these tests should be considered.

If you have a diagnosis of irritable bowel syndrome, these tests may exclude ulcerative colitis and Crohn’s disease.

Since as many as 10% of people with ulcerative colitis and Crohn’s disease may also have celiac disease, celiac blood tests should also be considered. Lactose intolerance is also common in IBD, IBS and celiac disease.

Future helpful information

On colitis, Crohn’s disease, celiac disease, food allergies, food intolerance, food sensitivity, eosinophilic esophagitis, and irritable bowel syndrome will be available from Dr. Scot Lewey, the food allergy expert-the food doc at http://www.thefooddoc.com.

Information on colitis and Crohn’s disease can also be obtained from the Crohn’s and Colitis Foundation of America (CCFA, http://www.ccfa.org).

Dr. Scot Lewey is a member of the medical advisory panel for the Rocky Mountain Chapter of CCFA. For more information about Prometheus Laboratories Inc. see http://www.prometheuslabs.com. A more detailed explanation of the blood tests can be found in a separate article by the food doc and references below.

Abreu MT et.al. Use of Serologic Tests for Crohns Disease. Clinical Gastroenterology and Hepatology. Vol.4, No. 3. 2001

Dotan I et.al. Antibodies Against Laminaribioside and Chitiobioside Are Novel Serologic Markers in Crohn’s Disease. Gastroenterology. Vol.131, No. 2. 2006

Mei, L et.al. Familial Expression of Anti-Escherichia coli Outer Membrane Porin C in Relatives of Patients with Crohn’s Disease. Gastroenterology. Vol. 130, No. 4 2006
Blood tests for Crohn’s disease are a relatively new and exciting development that has added significantly to the screening, diagnosis, and management of ulcerative colitis and Crohn’s disease. By Dr. Scot Lewey

Crohns Disease Blood Tests

War Inside Our Bodies Living with Inflammatory Disease

War Inside Our Bodies Living with Inflammatory Disease

War Inside Our Bodies Living with Inflammatory Disease, Our bodies rely on a complex immune system to keep us healthy, but for those with an inflammatory disease, it can feel as if their immune system has turned against them.

With International Day of Immunology coming up on 29 April, Rebecca Scott talks to researchers working to understand immune dysfunction in diseases such as MS and Inflammatory Bowel Disease.

Around the world, millions of people suffer from inflammatory diseases, which has some classifications.

War Inside Our Bodies Living with Inflammatory Disease

War Inside Our Bodies Living with Inflammatory Disease

In industrialized nations around five percent of the population suffers inflammatory disease resulting from autoimmune conditions where its immune responses directly attack the body’s tissues.

Although symptoms can vary significantly within the classification, the similarity between inflammatory disease caused by autoimmune failure and those resulting from other causes is that in both cases, white blood cells (T cells) that typically work to fight infection are not functioning correctly.

In short, the body’s natural immune system attacks its tissue instead of a foreign bacteria or invading infection, resulting in damage to the body’s tissues and the development of an autoimmune disease.

Read more: War Inside Our Bodies

Crohns Disease Risk Psoriasis

Crohns Disease Risk Psoriasis

Crohns Disease Risk Psoriasis, Psoriasis increases the risk of Crohn’s disease in women. Research revealed that women with psoriasis have a fourfold risk of developing Crohn’s disease, based on data from two large cohort studies. On the other hand, psoriasis did not increase the risk of ulcerative colitis in either cohort.

Reversing the association, an alternative study found a 13 percent psoriasis prevalence among patients with inflammatory bowel disease (IBD).

Crohns Disease Risk Psoriasis

Crohns Disease Risk Psoriasis

Researcher Abrar A. Qureshi said, “Certainly, this is a preliminary study, but it does begin to make sense because we are seeing patients with Crohn’s disease and psoriasis overlap. The inflammatory pathways that have been identified at the genetic level in genome-wide association studies make sense as well, because there is overlap in the interleukin-12 and interleukin-23 pathways in psoriasis and Crohn’s disease.”

The studies reveal similar pathways in IBD and psoriasis. Both Crohn’s disease and psoriasis are Th1-mediated conditions (which means, the immune system uses Th1 helper cells to eliminate what it mistakenly deems as invaders inside our cells). Ulcerative colitis is primarily mediated through the Th2 pathway (Th2 helpers work outside of the cells).

The researchers analyzed 174,646 participants in the Nurses’ Health Study (NHS) and NHS II. The researchers identified nearly 4,400 cases of psoriasis in the combined studies. Psoriasis patients were generally older, had a higher body mass index, were less active, consumed more alcohol, and were more likely to be smokers.

During follow-up (1996 to 2008 in NHS and 1991 to 2007 in NHS II), 423 study participants developed Crohn’s disease or ulcerative colitis.

Prevalence of psoriasis was four to six times greater in IBD patients than the estimated prevalence in the general public – which is two to three percent.

Read more: Risk Psoriasis

Specialists Building Medical Homes

Specialists Building Medical Homes

Specialists Can Build Their Own Medical Homes, Two years ago, Lawrence Kosinski, M.D., would tell people there’s no place like a specialty intensive medical home. Now he has the data to back it up.

Kosinski is managing partner of Illinois Gastroenterology Group, the state’s largest such practice, which has reduced spending for its patients with Crohn’s disease by almost 10 percent in 10 months.

“We’ve kept the patients healthier and kept them out of the hospital,” Kosinski says. “We’re showing strong positive results.”

With support from the Health Care Service Corp.-affiliate Blue Cross and Blue Shield of Illinois, Kosinski and IGG operate a specialty medical home whose foundation is technology-assisted patient engagement. The model has reduced hospital costs for patients with Crohn’s disease by 57 percent and emergency department costs by 53 percent.

Kosinski was serving as chairman of the American Gastroenterological Association’s practice management and economics committee when he saw how colonoscopies accounted for 54 percent of a typical gastroenterology practice’s income. He became concerned that his specialty relied too heavily on one procedure.

It was critical that gastroenterologists find additional ways to apply their special skills, Kosinski says. A study of two years’ worth of BCBSIL claims data on 21,000 patients suggested Crohn’s treatment could be where they might make the biggest difference.

The insurer was spending $240 million on Crohn’s treatment or $11,000 per patient, with half of it going for inpatient stays and often for “devastating complications” such as infections, bleeding, bowel obstructions or fistulas. About 10 percent of the costs were spent on pharmaceuticals and only 3.8 percent was going to gastroenterologists.

Read more: Specialists Can Build Their Own Medical Homes

Canada First Crohns Disease Center

Canada First Crohns Disease Center

Canada First Crohns Disease Center

Canada recently announced the nation’s first network for Crohn’s disease and ulcerative colitis patient care and research: Promoting Access and Care through Centres of Excellence (PACE). It is the most extensive Canadian collaboration for adults living with the two main manifestations of inflammatory bowel disease (IBD).

PACE will host a combination of independent and collaborative research that will take place over four years. During the first year, each center will drive their research, and in the following three years, all centers will collaborate to develop their specific strengths. Crohn’s and Colitis Canada will provide each center with $500,000.

According to a press release, Dr. Remo Panaccione, an international expert in IBD and the director of the University of Calgary’s IBD clinic since 2001, is one of five expert clinicians involved in the project. He will lead the Calgary center with Dr. Robert Fedorak, from the University of Alberta.

Canada First Crohns Disease Center

Canada First Crohns Disease Center

“The vision of PACE and the Calgary Inflammatory Bowel Disease Research Centre is to improve the quality of life of our patients with IBD —we will work to identify and target immune pathways in order to develop personalized therapies and biomarkers for disease surveillance,” said Panaccione who is also a member of the chronic disease-focused Snyder Institute for Chronic Diseases in the Cumming School of Medicine.

Calgary will be in charge of elevating the standard of care’s consistency

stablishing standard clinical practice procedures and treatments across the country. Calgary’s team will work to introduce technological alternatives for integrating best practices into healthcare.

The University of Calgary is teamed with the University of Alberta to develop standardized treatments, explicitly addressing the extended use of steroids. Steroids reduce inflammation and bring about improvement, but long-term use can also bring significant side effects. The application should be kept at a minimum.

“Our priority is reducing steroid use in Crohn’s disease and ulcerative colitis patients,” Panaccione said. “Three-quarters of patients referred to a specialist are on steroid treatment and our work will address this issue.”

Each year, Alberta sees 1,000 new IBD diagnoses. With 20,000 known cases in the province, when ranked by population, Alberta has among the highest levels of IBD burden in the world.

Read more: Canada First Crohns Disease Center

Canada First Crohns Disease Center

Seantrel Henderson Crohns Disease

Seantrel Henderson Crohns Disease

Seantrel Henderson Crohns Disease

With training camp less than a month away, one of the biggest questions surrounding the Buffalo Bills is who they’re going to have at right tackle come Week 1. It’s been a part of their roster that has been a question mark for a while.

Seantrel Henderson Crohns Disease

Seantrel Henderson Crohns Disease

Last season, Seantrel Henderson carried most of the load and did a decent job of it. However, his health concerns are an issue and it’s unclear if we have anyone else to replace him. If you don’t recall, Henderson was our 2014 seventh-round draft pick that was diagnosed with Crohn’s disease well into last season. He ended up missing the final five games of the season and is still not sure of a timetable on his return.

For most of this offseason, not much was said about their plans with Seantrel. It was, and still is, kind of just a waiting game. However, Bills’ GM Doug Whaley spat out some words of hope and optimism to Bills fans during an interview with WGR 550. Whaley stated that the Bills have heard good news on Henderson’s health and although they still aren’t sure on a timetable, he is moving in the right direction.

So far, the Bills have a few options to consider. The first is to just keep him on the roster and let him heal, hoping he comes back within the first few games of the season. The second, which is growing in popularity, is to place him on the NFI list and give him guaranteed time to heal.

The NFI list is the Non-Football Injury list, which is similar to the Physically Unable to Perform. While the PUP indicates they have an injury sustained while playing football, the NFI regards injuries and illnesses that happen outside of football. Like the PUP list, placing a player on the NFI list will keep him out of the first 6 weeks indefinitely.

The proto placing him on the NFI list is that we gain a roster spot, which we could use to replace him until he recovers. Also, it gives him more than enough time to recover and be ready to play start when he comes back. However, as I said above, we would be without him for at least six weeks. After those six weeks, the Bills can decide what they want to do with him. They can either activate him to the roster or keep him on the list. If he is kept on the list, he will be out for the rest of the season.

Read more: Seantrel Henderson Progress With Crohns Disease

Seantrel Henderson Crohns Disease