Blood test results

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Levi
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Date Joined Nov 2009
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   Posted 1/18/2010 1:27 PM (GMT -7)   
Hello. I'm hoping someone can help me make sense of my Prometheus test results:


ASCA IgA ELISA: <12.0
ASCA IgG ELISA: <12.0
Anti-OmpC IgA ELISA: 5.5

Anti-CBir1 ELISA >100.0 (Ref is less than 21)


IBD Specific pANCA:

AutoAntibody ELISA: 34.2
IFA Perinuclear pattern: Detected (normal is "Not Detected")
DNAse Sensitivity: Dnase Sensitive (Normal is "Not Detected)



I have been dianosed UC based on pathology and colonoscopy. The Prometheus test shows "pattern consistent with Crohn's disease." My GI does not believe that I have CD. The CD positive number that I had was the Anti-Cbir1 ELISA which was very high (>100.0). Here is what I have found online about this particular marker:



Approximately 50% of patients with Crohn's disease have a positive response to anti-CBir1. The presence of anti-CBir1 identifies a subset of patients with Crohn's disease who were not previously detected by other serologic markers. Before the introduction of anti-CBir1, patients who were pANCA positive may have been diagnosed as having ulcerative colitis. However, anti-CBir1 helps physicians to further characterize pANCA-positive patients and distinguish between ulcerative colitis and ulcerative colitis-like Crohn's disease.



So, is my GI right? Or does this high value point to UC instead of CD?



Any help would be greatly appreciatted.

Ides
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   Posted 1/18/2010 5:51 PM (GMT -7)   
Levi,
Did the GI disregard the Promethus findings? If so, why does he not believe the results? I know that some consider the Promethus testing as "experimental". If he does, then why the heck did he order it?

Sorry to answer your question with more questions. It appears from what you posted that it is more likely that you have CD instead of UC. Then again, there may be other variables that negate the high anti-CBir1. I am not as well versed in this as I would like to be.
Moderator Crohn's Disease  & Osteoarthritis Forums
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debilitated
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Date Joined Jan 2010
Total Posts : 448
   Posted 1/18/2010 6:08 PM (GMT -7)   
Those findings are correct but Where is your colitis located. Illium? Colon? Cecum?

Levi
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Date Joined Nov 2009
Total Posts : 1695
   Posted 1/18/2010 6:23 PM (GMT -7)   
I was with the PA that day. She disregarded the results and I'm seeing the GI Thursday. The test was ordered to see how my body would do with 6mp and this was "tacked on" I guess. The reason they disregarded my blood work was because the path report showed UC definitively. But that's why I'm so worried: can it not be both?

I have this off the chart anti-Cbir1 number, but path report shows continuous inflammation, inner layer only, rectum through sigmoid. He got all the way to the distal ileum in the colonoscopy and everything from sigmoid up looked completely normal.

So, two experiments, one definitive UC, one definitive CD. Does that mean both? :(

medchrt1
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Date Joined Sep 2005
Total Posts : 517
   Posted 1/18/2010 7:32 PM (GMT -7)   
can you verify the absence of any value or result, after the colon
in the line that reads
"IBD Specific pANCA:"   ?

Levi
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Date Joined Nov 2009
Total Posts : 1695
   Posted 1/19/2010 4:30 AM (GMT -7)   
medchrt1: It is blank, but it looks to me like it is a column heading for the last three readings. I probably shouldn't have put a colon there.

beave
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Date Joined Mar 2007
Total Posts : 1091
   Posted 1/19/2010 1:47 PM (GMT -7)   
^ That's right; it's a column heading, for the next three rows.

I have a couple of comments.

First, based on your description, I would say you most likely have Crohn's disease, and in particular a subtype of Crohn's disease that mimics ulcerative colitis. That would explain your blood results AND explain why your colonoscopy results led your GI to believe you have UC.

You said the colonoscopy path report said UC definitively, but it doesn't quite work that way. There is no way for the path report to diagnose UC definitively. The path report can diagnose Crohn's definitively - if a granuloma is found to be present; but the lack of a granuloma does not mean that it's definitely UC. Like I said, your path report can be *consistent* with UC, and your colonoscopy results can be *consistent* with UC as well, but there is also a subtype of Crohn's that fits these characteristics. And from your blood tests, I'd say that's likely your case.

In any event, consider that it's not even an either/or question to begin with. The whole notion of IBD being either UC or Crohn's is an oversimplification. It's not black and white. There's a spectrum of IBD. In the coming years I think we'll see dozens of subtypes identified, with the result being that the terms Crohn's and UC become obsolete.

Further, whichever you have, your treatment is similar. The only critical difference is that for UC, a total colectomy is curative, whereas with Crohn's it's not.

Levi
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Date Joined Nov 2009
Total Posts : 1695
   Posted 1/20/2010 9:16 AM (GMT -7)   
I posted this on the UC forum also:

Well, I just got back from my appt. with the GI. He spent a ton of time (>45 minutes) talking over everything with me, which was great. It seems like, based on the blood test, he thinks I could now be labled "Crohn's colitis." I asked him if that meant he thought I would have extra intestinal manifestations like that normal CD patients do, and he said no. I asked if he thought the disease would ever affect my GI tract outside of the large bowel and he said no.

I didn't think about this until on the way home, but I should have asked him this: If my symptoms are going to be exactly like a typical ulcerative colitis patient, and he doesn't expect me to have symptoms typical of Crohn's, what exactly is the difference between ulcerative colitis and Crohn's colitis?

Anybody know? Can I expect bowel thickening? The inflammation to affect more than just the inner layer?

Illini
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Date Joined Dec 2007
Total Posts : 298
   Posted 1/20/2010 10:04 AM (GMT -7)   
May or may not be relevant but I will mention that Cbir1 antigen is also present in uropathogenic E. coli bacteria. If you have ever had a urinary tract infection / bladder infection / or any other infection due to E. coli, it is possible that you developed an antibody, independent of your bowel problems.
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Levi
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Date Joined Nov 2009
Total Posts : 1695
   Posted 1/20/2010 11:02 AM (GMT -7)   
Dangit, Illini, I was going to ask him that based on some of your very own posts I read this week that you wrote in '07 and '08. I talked myself out of it though, becuase in one of your posts, you said you had recently had a UTI and thought that's why it threw your result off. My UTI was probably six years ago, could that still have an effect on my anti-Cbir1 reading (>100)? And...could it have that much affect, to make it 5x upper limit of normal?

Man I wished I had brought that up...
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