Frecuencia de autoanticuerpos y niveles de calprotectina fecal en un grupo de pacientes con enfermedad inflamatoria intestinal

La enfermedad inflamatoria intestinal (EII) comprende dos entidades, la colitis ulcerativa (CU) y la enfermedad de Crohn (ECr). La evidencia sugiere que la EII es el resultado de una inapropiada respuesta inflamatoria a la flora intestinal en el contexto de un paciente con susceptibilidad genética. Dentro de sus principales manifestaciones extra intestinales, se encuentran las artritis periféricas y el compromiso axial articular definidas como espondiloartritis (EAS). Es importante anotar que un gran número de pacientes que no cumplen criterios diagnósticos pueden quedar agrupados como síndrome de intestino irritable asociado a diarrea, o colitis inespecífica en los cuales podrían emplearse estudios serológicos complementarios. El algoritmo diagnóstico de la EII incluye una tamización en suero para anticuerpos anti Saccharomyces cerevisae (ASCAS) IgG/IgA y anticuerpos anti citoplasma del neutrófilo con patrón perinuclear (ANCAS), sin embargo estas pruebas no son frecuentemente solicitadas por desconocimiento o por falta de disponibilidad de recursos tecnológicos o infraestructura. Esta patología genera una respuesta inmune ante antígenos normalmente tolerados; en este sentido, los linfocitos T actúan tanto en el origen como en el mantenimiento de las mismas, siendo uno de los mecanismos un perfil de secreción de citoquinas alterado, que es necesario estudiar a nivel sistémico para profundizar el entendimiento de la fisiopatología y poder plantear nuevos blancos terapéuticos. Palabras clave: Enfermedad Inflamatoria Intestinal, artropatías inflamatorias crónicas, enfermedad de Crohn, Colitis Ulcerativa, CalprotectinaHOPITAL MILITAR CENTRALInflammatory bowel disease (IBD) comprises two entities, ulcerative colitis (UC) and Crohn's disease (CrD). Evidence suggests that IBD results from an inappropriate inflammatory response in the intestinal flora in the context of a patient with a genetic susceptibility. Among its main extra-intestinal manifestations are peripheral arthritis and joint involvement defined as axial spondyloarthritis (SpA). It is important to note that a large number of patients who do not meet diagnostic criteria can be grouped as irritable bowel syndrome associated with diarrhea, or nonspecific colitis in which complementary serological studies could be used. The IBD diagnostic algorithm includes a screening for serum antibodies Saccharomyces cerevisiae (ASCAs) IgG / IgA and anti-neutrophil cytoplasm antibodies with perinuclear pattern (ANCA), however these tests are not often requested by ignorance or lack of availability technological resources or infrastructure. This condition generates an immune response against antigens normally tolerated and in this connection, T cells act in both the source and the maintenance of them, one of the mechanisms profile altered cytokine secretion, it is necessary to look at the level systemic to deepen understanding of the pathophysiology and new therapeutic targets to raise. Key words: Inflammatory bowel disease, chronic inflammatory arthritis, Crohn's disease, Ulcerative Coliti

Autoantibodies and fecal calprotectin levels in a group of Colombian patients with inflammatory bowel disease

Background: The purpose of the study is to investigate the frequency of serum anti-Saccharomyces cerevisiae antibodies (ASCA), anti-neutrophil cytoplasmic antibodies (ANCA), anti-nuclear antibodies (ANAS), IgA, C reactive protein (CRP), erythrocyte sedimentation rate (ESR) and fecal calprotectin (FC) and its association between diagnosis, endoscopic findings, histopathologic and clinical activity, in patients with diagnosis or suspected inflammatory bowel disease (IBD). Methods: An observational cross-section study was designed including 52 patients with IBD or suspected IBD. ASCA, ANCA, ANAS, IgA, CRP, ESR and FC were measured. Patients were divided according to histological findings into ulcerative colitis (UC), Crohn's disease (CD) and others (normal mucosa, chronic proctocolitis, nonspecific colitis and ileitis). A descriptive analysis was made and associations were evaluated using chi2 test, Kruskal Wallis and Mann- Whitney U test. Results: The association between IBD and ASCA levels was statistically significant (p=0.036). ANCA levels showed statistical significance in IBD patients (p=0.048). When comparing FC levels within UC, CD and others a statistical significance was obtained (p=0.032). A large percentage of patients (78.5%) with high positive levels FC were classified as active histopathology. A significant percentage (54.5%) with levels up to 50 mg/kg had quiescent activity. Positive levels of FC were related with serum activity markers with statistical significance (CRP: p=0.007 and ESR: p=0.003). Conclusions: The frequencies of p-ANCA and ASCAs for UC and CD were established in a Colombian population. IBD patients with histopathologic activity had higher levels of FC. We also found that patients with quiescent disease have elevated FC levels