Predicting a Change in Diagnosis From Ulcerative Colitis to Crohn's Disease: A Nested, Case-Control Study

Gil Y. Melmed, Robert Elashoff, Gary C. Chen, Igor Nastaskin, Konstantinos Papadakis, Eric A. Vasiliauskas, Weiqing Liu, Carol Landers, Andrew F. Ippoliti, Stephan R. Targan

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)602-608
Number of pages7
JournalClinical Gastroenterology and Hepatology
Volume5
Issue number5
DOIs
StatePublished - May 1 2007
Externally publishedYes

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Ulcerative Colitis
Crohn Disease
Case-Control Studies
Weight Loss
Diarrhea
Pseudomonas fluorescens
Porins
Antineutrophil Cytoplasmic Antibodies
Escherichia coli Proteins
Colonoscopy
Saccharomyces cerevisiae
Databases
Inflammation
Membranes
Antibodies
Serum

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Predicting a Change in Diagnosis From Ulcerative Colitis to Crohn's Disease : A Nested, Case-Control Study. / Melmed, Gil Y.; Elashoff, Robert; Chen, Gary C.; Nastaskin, Igor; Papadakis, Konstantinos; Vasiliauskas, Eric A.; Liu, Weiqing; Landers, Carol; Ippoliti, Andrew F.; Targan, Stephan R.

In: Clinical Gastroenterology and Hepatology, Vol. 5, No. 5, 01.05.2007, p. 602-608.

Research output: Contribution to journalArticle

Melmed, GY, Elashoff, R, Chen, GC, Nastaskin, I, Papadakis, K, Vasiliauskas, EA, Liu, W, Landers, C, Ippoliti, AF & Targan, SR 2007, 'Predicting a Change in Diagnosis From Ulcerative Colitis to Crohn's Disease: A Nested, Case-Control Study', Clinical Gastroenterology and Hepatology, vol. 5, no. 5, pp. 602-608. https://doi.org/10.1016/j.cgh.2007.02.015
Melmed, Gil Y. ; Elashoff, Robert ; Chen, Gary C. ; Nastaskin, Igor ; Papadakis, Konstantinos ; Vasiliauskas, Eric A. ; Liu, Weiqing ; Landers, Carol ; Ippoliti, Andrew F. ; Targan, Stephan R. / Predicting a Change in Diagnosis From Ulcerative Colitis to Crohn's Disease : A Nested, Case-Control Study. In: Clinical Gastroenterology and Hepatology. 2007 ; Vol. 5, No. 5. pp. 602-608.
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abstract = "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.",
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T2 - A Nested, Case-Control Study

AU - Melmed, Gil Y.

AU - Elashoff, Robert

AU - Chen, Gary C.

AU - Nastaskin, Igor

AU - Papadakis, Konstantinos

AU - Vasiliauskas, Eric A.

AU - Liu, Weiqing

AU - Landers, Carol

AU - Ippoliti, Andrew F.

AU - Targan, Stephan R.

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N2 - 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.

AB - 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.

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