Clinical significance of anti-Saccharomyces cerevisiae antibody (ASCA) in Korean patients with Crohn's disease and its relationship to the disease clinical course

BACKGROUNDS/AIMS: The implications of anti-Saccharomyces cerevisiae antibody for the diagnosis and the clinical course of Crohn's disease have been reported in Western countries, but rarely in Korea with its very different environmental and genetic backgrounds. We aimed to evaluate whether anti-S. cerevisiae antibody expression is associated with diagnostic findings, stratified Vienna classification phenotypes, disease activity and clinical course in Korean patients with Crohn's disease. MATERIALS/METHODS: One hundred and fifteen patients with Crohn's disease, diagnosed and treated between 1990 and 2004 at Severance Hospital, Yonsei University and followed for at least 2 years, were included in this study. Anti-S. cerevisiae antibody was detected by an indirect immunofluorescence assay using EUROIMMUN kits. Information collected during treatment included demography, Vienna classification phenotype, clinical manifestation, laboratory tests, treatment modality and surgery rate. Disease activity was measured monthly using the Harvey-Bradshaw index. RESULTS: The anti-S. cerevisiae antibody prevalence was 38.3% in Crohn's disease patients. There was no difference in anti-S. cerevisiae antibody expression between genders. The mean age at diagnosis was younger for the anti-S. cerevisiae antibody positive group than the negative group (25.3 years versus 29.7 years, p<0.05). Clinical manifestations and laboratory tests at diagnosis did not differ between the groups. The anti-S. cerevisiae antibody positive group had increased fibrostenosis (B2) and penetration (B3) compared to negative group, as determined by the Vienna classification (75.0% versus 53.5%, p<0.05). Anti-S. cerevisiae antibody positive patients were admitted to the hospital more frequently than anti-S. cerevisiae antibody negative patients (p<0.05). The yearly cumulative Harvey-Bradshaw index score was higher in the anti-S. cerevisiae antibody positive group than in the negative group during the follow-up period (p<0.05). In addition, steroid (72.7% versus 52.1%, p<0.05) and immunosuppressive (45.5% versus 23.9%, p<0.05) treatments were more frequently given to the anti-S. cerevisiae antibody positive group. CONCLUSIONS: Our data demonstrate that anti-S. cerevisiae antibody positive Crohn's disease patients had a more severe clinical course and thus often required more aggressive medical treatment.