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skofbengsk
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Date Joined Oct 2006
Total Posts : 229
   Posted 3/12/2013 12:51 AM (GMT -6)   
wondering who here has had the ASCA test and it came back positive? What did They tell you about it? I have done a search here in the forum and found some posts but no one here seems to know exactly what the test is saying or actually testing.

Ides
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Date Joined Nov 2003
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   Posted 3/12/2013 4:27 PM (GMT -6)   
"ASCA (Saccharomyces cerevisiae antibodies), IgG and IgA. ASCA is more common with CD; it is found in about 40% to 50% of those with CD. ASCA IgG is found in about 20% of those with UC. ASCA IgA is found in less than 1% of those with UC. "

This is one of several antibodies that some doctors test for when they suspect a person has Crohn's or UC. Several health insurance carriers will not pay for any of these antibody tests because they are considered experimental as far as a diagnostic tool.

I had this test and the others done through Prometheus Labs. one was positive, the Anti-Omp C.
Moderator Crohn's disease, Osteoarthritis and Irritable Bowel Forums

CD, Ankylosing Spondylitis, small fiber peripheral neuropathy, avascular necrosis, peripheral artery disease, pulmonary hypertension, degenerative disc disease, asthma, severe allergy and a host of other medical problems.

skofbengsk
Regular Member


Date Joined Oct 2006
Total Posts : 229
   Posted 3/12/2013 7:35 PM (GMT -6)   
Thanks, several of the studies I read ran three tests at once, pANCA, Anti-OmpC, and ASCA, I have read around and found that the Panca is some sort of immune response to white blood cells and an indicator for UC, I still have not ben able to find anything on what the anti-OmpC is testing for, though I don't think it is generally a test indicative of crohns if you know what the test is for then of course I am very interested in finding out.
My main curiosity at this time is the ASCA bc what it is is a reaction to yeast, if you take the anti out of the ASCA you get yeast. So being that I had an IgG series for food intolerance and my yeast was as high as it could get, I eliminated all yeast from my diet along with the several other foods I tested positive for and have maintained remission for over two years 100% med free. My GI's still insist that food has nothing to do with crohns. I have been looking, and even the old posts on here from people who have had the test do not mention anything about knowing the fact that it is an antibody against yeast. I did find an old study from Hungary I think 2003, that said either TPN or a complete forbidding of yeast can be "an acceptable alternative in case of getting well". I am just kinda ticked that the Dr's know that the 60-80% of us that test positive on ASCA yet fail to inform us that this is a reaction to something that can be avoided, and remission can be obtained by avoiding it. Even more so I am mad bc it is shown that those of us with the ASCA tend to have more severe course of disease and higher necessity for surgery! So being that my colon was removed 5yrs after my first flare and living in hell for 5 1/2 yrs until I found a GP that ran the food allergy test is pretty disheartening. I am not sure exactly what tests were used in determining my crohns other than the colonoscopy finally proved it, I gave a lot of blood during the process. I had never heard of ASCA until my food panel came back and I googled yeast allergies and crohns, all of a sudden I find out that they have been studying this for over two decades. But other than SCD being bakers yeast free(but not completely yeast free) I do not recall anywhere in "breaking the vicious cycle" yeast itself being mentioned, other than candida over growth which is not what this is. I have never, besides the study from Hungary, heard it mentioned that we should even possibly avoid yeast. And I have obsessively read and researched this disease for years!!!!! But unless you specifically type in "yeast intolerance and crohns" you don't find anything. Grrrrr
So I am super curious about the people who know they have had the test and they tested positive for it if any of their Dr's bothered to mention the fact that it is a reaction to yeast? I think other than my ranting on here over the past couple of years not many people have heard of yeast being a possibly huge contributor to their disease status, and I think most of you think I am crazy bc I am the only one talking about it:( It is real!!

Post Edited (skofbengsk) : 3/12/2013 7:00:13 PM (GMT-6)


skofbengsk
Regular Member


Date Joined Oct 2006
Total Posts : 229
   Posted 3/12/2013 7:59 PM (GMT -6)   
Ok, I found the Anti- OmpC, apparently it is a an anit-body formed against "outer membrane porin protein C". So that along with the pANCA must be where the information comes from that crohns is an auto-immune disease in which the body for unknown reasons starts attacking itself? I have read that several times but explanation was never given. I always wondered where they came up with that theory. and now I do, maybe.
Dx CD Oct '06 mom of 3 boys
Past Meds: prednisone, Lialda, Asacol, entocort, flagyl, cipro

London Lurker
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Date Joined Feb 2013
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   Posted 4/29/2013 5:15 PM (GMT -6)   
I'm a UC person, at least I think I am, one biopsy suggested Crohns but then they returned to a UC diagnosis. Came to this post through a search on if kefir could make IBD worse.

I just tried adding in kefir, which everyone talks of as being wonderful but it definitely seems to make me bleed. I was looking at the bacteria in it, most of which are in my VSL#3 which helps so thought it can't be them and don't think it is the dairy as I can tolerate some dairy, then saw that the main listed difference is Saccharomyces cerevisiae. I was wondering if it was possible that this is causing me the problem, although I can eat baked yeast products, I read somewhere that raw yeast can be harder to tolerate, I don't know if it is raw yeast in kefir but I guess it is?

Anyway, I have never had an ASCA test and have no idea where I could get one in the UK where I am, I don't think the team I am under would agree to it as it is not in the guidelines.

I too was really wondering though, if one has ANCA antibodies, does that mean yeast will set the immune system off? Am thinking it can't be that simple or surely people would be tested and warned? It is very confusing.
Proctitis 1984
Pan Colitis 1988
No major flare ups since, many well years between mild to moderate flares, some years without meds
No special diet other than low fibre and rare alcohol
Currently Mezavant XL x 2 per day
Salofalk Enema x 1 per day
B complex sublingual
Vit D (ceased K2)
Probiotics sometimes - started Mutaflor, VSL#3 March '13, good results so far

March '13 10 days on Flagyl

skofbengsk
Regular Member


Date Joined Oct 2006
Total Posts : 229
   Posted 4/30/2013 12:00 AM (GMT -6)   
Unfortunately, the first study I came across I think was in 1988, and the suggestion was that enteral nutrition or a complete restriction of yeast could be warranted. However of the many tests on ACSA that have been done since then, (which have all confirmed that 60-80% of UC has it while I think it was like 5-10% of UC), have only been to find out if testing for ASCA would be useful for diagnosis. What no Dr's tell you is that restricting yeast can make a huge difference if you test positive. My bakers yeast was a 4 out of 4, while brewers was a 3. I however am sensitive to all yeast molds and mushrooms, others might not be bothered as much. I can tell you that MSG bothers me way more than a hamburger bun or a slice of bread. I had the 156 food IgG panel and tested positive for 14 different foods, but yeast was the highest, the others were 1 and 2's. And I also had an issue with Kefir, my dr recommended it before my allergy results came back and I knew the first time I drank it that something was wrong. I can have greek yogurt or SCD yogurt with no issue.

If you can't get the test you could restrict yeast for 2-4wks (the longer the better, but it is hard) then challenge it and see how it goes. But remember that sometimes the reaction takes a day or two, so make sure to keep a symptom/food diary. Sometimes I feel it within minutes or hrs, sometimes not till the next day. Sometimes it takes 2-3days of too much bad stuff which has an accumulation effect.
Dx CD Oct '06 mom of 3 boys
Past Meds: prednisone, Lialda, Asacol, entocort, flagyl, cipro

skofbengsk
Regular Member


Date Joined Oct 2006
Total Posts : 229
   Posted 4/30/2013 12:17 AM (GMT -6)   
Also, look back to a post I did last month "recent study on crohns" there is a link to an abstract article, I think I may have even posted a link to the actual study. Also to remember, someone had issue to the fact that the people in the study were already in remission when they did the challenge, however if you read the actual study they were already in remission with the diet changes after allergy testing and the study simply proved that challenging foods that were IgG positive induced CD symptoms.
Dx CD Oct '06 mom of 3 boys
Past Meds: prednisone, Lialda, Asacol, entocort, flagyl, cipro

London Lurker
Veteran Member


Date Joined Feb 2013
Total Posts : 680
   Posted 4/30/2013 3:01 PM (GMT -6)   
Thank you for coming back. Good to "meet" someone else who struggles with kefir (not that I'd wish it on you of course!) because it is confusing to not get along with a food that everyone else seems to find so helpful.

I have never done a IgG panel as I have heard conflicting reports about its validity. Probably worth doing though.

As far as food sensitivities, the "message" from all the consultants I have been under is that UC is not sensitive to diet, Crohns is, I don't find that to be the case though for me.
Proctitis 1984
Pan Colitis 1988
No major flare ups since, many well years between mild to moderate flares, some years without meds
No special diet other than low fibre and rare alcohol
Currently Mezavant XL x 2 per day
Salofalk Enema x 1 per day
B complex sublingual
Vit D (ceased K2)
Probiotics sometimes - started Mutaflor, VSL#3 March '13, good results so far

March '13 10 days on Flagyl

skofbengsk
Regular Member


Date Joined Oct 2006
Total Posts : 229
   Posted 4/30/2013 3:39 PM (GMT -6)   
That is a little hilarious that you say your Dr's say that about crohns and UC, My GI's still thinks food has nothing to do with it and don't have any faith in my test results, but the proof is in the pudding lol, 2yrs no problems, except when I eat something I shouldn't. My sister has UC and hasn't had the test done either, it is expensive and there is only one Dr in our area that does it. She does think she has issues with some yeast but isn't sure because she seems to tolerate nutritional yeast. She does definitely have issues with wheat breads in general. Also her problem tends more towards constipation, and I would assume that a slower transit time might mean a longer period of time until there is a reaction, where as my transit time is extremely fast and it generally only takes hrs for my food to make it that far. Minutes if it is really the wrong thing lol.

They have even done familial studies on people with CD and their relatives both affected and healthy and they found that the yeast intolerance can also be in the healthy family members who are IBD free. I remember knowing that I felt better if I did not eat even as a small child and arguing having to eat breakfast and generally throwing all or most of my lunch away. Mom was big on healthy well rounded meals which always included a meat, grain(usually bread), and fruits and veggies, she thought it was the right thing at the time of course 4 out of her 5 children have a form of IBD. I noticed a direct correlation with breads and alcohols in my early 20's, yet didn't have any CD symptoms until my mid-late 20's and had my first flare just before my 30th B-day. It took almost 8mo for a diagnosis. I went back to school at around 26 and fast food and boxed meals were pretty much a daily occurrence during that time, which possibly ultimately led to the CD. So I think that the yeast issue may have been there since early childhood but it took years of going unchecked to progress to the state that it did. And it seems to get better the longer I avoid it, but I am not sure it will ever go away.

As far as hearing they aren't reliable, I am highly suspicious of the labs who claim to be able to test saliva and the ones who will do the test without a Dr's order. For me it was an absolute Godsend that I found a GP that would do it, at the time of the test I had never heard anything about ASCA. I had read a book that talked about the IgG food connection but I don't recall anything about yeast. for me yeast was the biggest but there were a few milder ones that I had no clue about, only one that I had definitely figured out for myself. But the others I think I could probably do ok not knowing, but every little bit helps. A theory about the yeast intolerance is that it may stem from a candida overgrowth and the body starts to over react to all yeast. I was the child who ate spoonfulls of sugar and loaded up handfuls of sugar cubes to suck on at church functions, as well as entirely too much soda in my teens and early adulthood. So in my case it sounds like a very likely scenario.

Whether or not you decide to pursue IgG testing a good rotation diet, limiting foods to atleast only once every 4 days is recommended to ward off inflammation. I have heard of it used for MS and other inflammatory diseases. Of course it is difficult and you have to be very creative when shopping, but helps minimize bombarding your body with foods you might possibly be reacting to.
Dx CD Oct '06 mom of 3 boys
Past Meds: prednisone, Lialda, Asacol, entocort, flagyl, cipro

London Lurker
Veteran Member


Date Joined Feb 2013
Total Posts : 680
   Posted 4/30/2013 3:57 PM (GMT -6)   
I was a sugar fiend too. 4 out of 5 children with IBD sounds so unlucky.

Since learning that mesalazine likely has anti-fungal properties, it has got me thinking more and more about the possibility of a fungus involved in IBD - yet surely research would have found that by now. When you read about fungus feed on the body, getting through tissues and cells and releasing toxins, it does sound like a description of an ulcerated colon. Yet clearly it is not some obvious, identifiable organism causing this or it would have been found.
Proctitis 1984
Pan Colitis 1988
No major flare ups since, many well years between mild to moderate flares, some years without meds
No special diet other than low fibre and rare alcohol
Currently Mezavant XL x 2 per day
Salofalk Enema x 1 per day
B complex sublingual
Vit D (ceased K2)
Probiotics sometimes - started Mutaflor, VSL#3 March '13, good results so far

March '13 10 days on Flagyl

skofbengsk
Regular Member


Date Joined Oct 2006
Total Posts : 229
   Posted 4/30/2013 4:30 PM (GMT -6)   
My conclusion is: They study stuff but don't do anything with it unless it involves billions of $$$ in drug therapy or expensive testing.


http://www.ncbi.nlm.nih.gov/pubmed/19471251


Am J Gastroenterol. 2009 Jul;104(7):1745-53. doi: 10.1038/ajg.2009.225. Epub 2009 May 26.

Candida albicans colonization and ASCA in familial Crohn's disease.

Standaert-Vitse A, Sendid B, Joossens M, François N, Vandewalle-El Khoury P, Branche J, Van Kruiningen H, Jouault T, Rutgeerts P, Gower-Rousseau C, Libersa C, Neut C, Broly F, Chamaillard M, Vermeire S, Poulain D, Colombel JF.


Source

INSERM, U799, Faculté de Médecine, Pôle Recherche, Université de Lille 2, Lille, France.


Abstract


OBJECTIVES:

Anti-Saccharomyces cerevisiae antibodies (ASCAs) are present in 50-60% of patients with Crohn's disease (CD) and in 20-25% of their healthy relatives (HRs). The yeast, Candida albicans, has been shown to generate ASCAs, but the presence of C. albicans in the digestive tract of CD patients and their HRs has never been investigated. Therefore, we studied C. albicans carriage in familial CD and its correlation with ASCAs.

METHODS:

Study groups consisted of 41 CD families composed of 129 patients and 113 HRs, and 14 control families composed of 76 individuals. Mouth swabs and stool specimens were collected for isolation, identification, and quantification of yeasts. Serum samples were collected for detection of ASCAs and anti-C. albicans mannan antibodies (ACMAs).

RESULTS:

C. albicans was isolated significantly more frequently from stool samples from CD patients (44%) and their HRs (38%) than from controls (22%) (P<0.05). The prevalence of ACMAs was similar between CD patients, their HRs, and controls (22, 19, and 21%, respectively, P=0.845), whereas the prevalence of ASCAs was significantly increased in CD families (72 and 34% in CD and HRs, respectively, in contrast to 4% in controls, P<0.0001). AMCA levels correlated with C. albicans colonization in all populations. ASCA levels correlated with C. albicans colonization in HRs but not in CD patients.

CONCLUSIONS:

CD patients and their first-degree HRs are more frequently and more heavily colonized by C. albicans than are controls. ASCAs correlate with C. albicans colonization in HRs but not in CD. In HRs, ASCAs could result from an altered immune response to C. albicans. In CD, a subsequent alteration in sensing C. albicans colonization could occur with disease onset.


PMID: 19471251 [PubMed - indexed for MEDLINE]
Dx CD Oct '06 mom of 3 boys
Past Meds: prednisone, Lialda, Asacol, entocort, flagyl, cipro

skofbengsk
Regular Member


Date Joined Oct 2006
Total Posts : 229
   Posted 4/30/2013 4:44 PM (GMT -6)   
Unfortunately, if we want real answers we have to look for ourselves,

I find this one difficult to follow, but I get the gist of it I think:

http://www.ncbi.nlm.nih.gov/pubmed/17919633



This one is obvious:

http://www.ncbi.nlm.nih.gov/pubmed/16697740


Gastroenterology. 2006 May;130(6):1764-75.

Candida albicans is an immunogen for anti-Saccharomyces cerevisiae antibody markers of Crohn's disease.

Standaert-Vitse A, Jouault T, Vandewalle P, Mille C, Seddik M, Sendid B, Mallet JM, Colombel JF, Poulain D.


Source

Inserm, U799, Lille, France.


Abstract


BACKGROUND AND AIMS:

Antibodies directed against oligomannose sequences alpha-1,3 Man (alpha-1,2 Man alpha-1,2 Man)(n) (n = 1 or 2), termed anti-Saccharomyces cerevisiae antibodies (ASCAs) are markers of Crohn's disease (CD). S. cerevisiae mannan, which expresses these haptens, is used to detect ASCA, but the exact immunogen for ASCA is unknown. Structural and genetic studies have shown that Candida albicans produces mannosyltransferase enzymes that can synthesize S cerevisiae oligomannose sequences depending on growth conditions. This study investigated whether C. albicans could act as an immunogen for ASCA.

METHODS:

Sequential sera were collected from patients with CD, systemic candidiasis, and rabbits infected with C. albicans. Antibodies were purified by using chemically synthesized (Sigma) ASCA major epitopes. These affinity-purified antibodies and lectins were then used to analyze the expression of ASCA epitopes on molecular extracts and cell walls of C. albicans and S cerevisiae grown in various conditions.

RESULTS:

In humans and rabbits, generation of ASCA was shown to be associated with the generation of anti-C. albicans antibodies resulting specifically from infection. By using affinity-purified antibodies, C. albicans was shown to express ASCA epitopes on mannoproteins similar to those of S. cerevisiae. By changing the growth conditions, C. albicans mannan was also able to mimic S. cerevisiae mannan in its ability to detect ASCA associated with CD. This overexpression of ASCA epitopes was achieved when C. albicans grew in human tissues.

CONCLUSIONS:

C. albicans is one of several immunogens for ASCA and may be at the origin of an aberrant immune response in CD.


Related to UC specifically:

http://www.ncbi.nlm.nih.gov/pubmed/19439813
Display Settings:
Abstract

J Physiol Pharmacol. 2009 Mar;60(1):107-18.

Effect of Candida colonization on human ulcerative colitis and the healing of inflammatory changes of the colon in the experimental model of colitis ulcerosa.

Zwolinska-Wcislo M, Brzozowski T, Budak A, Kwiecien S, Sliwowski Z, Drozdowicz D, Trojanowska D, Rudnicka-Sosin L, Mach T, Konturek SJ, Pawlik WW.


Source

Department of Physiology, Jagiellonian University Medical College, 16 Grzegorzecka Street, Cracow, Poland.


Abstract


The influence of fungal colonization on the course of ulcerative colitis (UC) has not been thoroughly studied. We determined the activity of the disease using clinical, endoscopic and histological index (IACH) criteria in UC patients with fungal colonization and the healing process of UC induced by an intrarectal administration of trinitrobenzene sulfonic acid (TNBS) in rats infected with Candida, without and with antifungal (fluconazole) or probiotic (lacidofil) treatment. The intensity of the healing of the colonic lesions was assessed by macro- and microscopic criteria as well as functional alterations in colonic blood flow (CBF). Myeloperoxidase (MPO) content and plasma proinflammatory cytokines IL-1beta and TNF-alpha levels were evaluated. Candida more frequently colonized patients with a history of UC within a 5-year period, when compared with those of shorter duration of IBS. Among Candida strains colonizing intestinal mucosa, Candida albicans was identified in 91% of cases. Significant inhibition of the UC activity index as reflected by clinical, endoscopical and histological criteria was observed in the Candida group treated with fluconazole, when compared to that without antifungal treatment. In the animal model, Candida infection significantly delayed the healing of TNBS-induced UC, decreased the CBF and raised the plasma IL-1beta and TNF-alpha levels, with these effects reversed by fluconazole or lacidofil treatment. We conclude that 1) Candida delays healing of UC in both humans and that induced by TNBS in rats, and 2) antifungal therapy and probiotic treatment during Candida infection could be beneficial in the restoration and healing of colonic damage in UC.
Dx CD Oct '06 mom of 3 boys
Past Meds: prednisone, Lialda, Asacol, entocort, flagyl, cipro

London Lurker
Veteran Member


Date Joined Feb 2013
Total Posts : 680
   Posted 4/30/2013 5:17 PM (GMT -6)   
Thank you for posting. A lot to read and thing about there.
Proctitis 1984
Pan Colitis 1988
No major flare ups since, many well years between mild to moderate flares, some years without meds
No special diet other than low fibre and rare alcohol
Currently Mezavant XL x 2 per day
Salofalk Enema x 1 per day
B complex sublingual
Vit D (ceased K2)
Probiotics sometimes - started Mutaflor, VSL#3 March '13, good results so far

March '13 10 days on Flagyl

London Lurker
Veteran Member


Date Joined Feb 2013
Total Posts : 680
   Posted 4/30/2013 5:23 PM (GMT -6)   
I have also read that almonds have anti-fungal properties which could explain why some people find SCD diet with its high almond flour content helpful?

There's a bunch of people on the colitis forum eating a lot of sunflower seeds with success they say - also anti-fungal I believe?
Proctitis 1984
Pan Colitis 1988
No major flare ups since, many well years between mild to moderate flares, some years without meds
No special diet other than low fibre and rare alcohol
Currently Mezavant XL x 2 per day
Salofalk Enema x 1 per day
B complex sublingual
Vit D (ceased K2)
Probiotics sometimes - started Mutaflor, VSL#3 March '13, good results so far

March '13 10 days on Flagyl

big betty
Regular Member


Date Joined Nov 2010
Total Posts : 461
   Posted 4/30/2013 5:41 PM (GMT -6)   
Hi There,
Yes, Positive for yeast on the Prometheus test and also on an IGG food panel. I stay away from yeast and mold foods and also try not to touch mold as I read it can go through the skin. If a person has inflammation then their intestinal barrier is compromised, molecules find their way through and the body can make antibodies to stuff that is normally not harmful such as proteins from food and yeast. This is how my GI explained it to me.
I miss yeasty, moldy pizza!

skofbengsk
Regular Member


Date Joined Oct 2006
Total Posts : 229
   Posted 4/30/2013 7:09 PM (GMT -6)   
London lurker: those are just a couple I have found specifically, if you go to Pub Med and enter Candida albicans, Ulcerative Colitis, or Candida Albicans, Crohns disease you will find pages of studys, some are only in animals some in people some in both. But I have yet to see any that showed it wasn't pertinent, although not all patients had Candida Albicans overgrowth. But still worthwhile to look into if you think it might be an issue for you.
I eat sunflower sprouts occasionally but they turn fast so I don't eat them as often as I could. And I developed an intolerance to almonds after about 6mo of almost daily use of almond flour when I cut wheat and Yeast. Now a single almond will throw me into a wild fit of acid D for hours. I obviously didn't follow the rotation diet on that one:( I find baking soda water aids in clearing the yeast from my intestines but done too often will send me into a massive die off reaction so I don't do that as often as I should either. Would probably benefit if I did it once or twice a week.

Big Betty: I haven't noticed mold issues so much by touching it though I try not to, but breathing it inadvertently has proven a fairly bad issue and has caused lung infections (love to garden). And just breathing in my house if an orange or banana goes unnoticed for a period, I will get burning eyes and throat and headaches and must go in search of the source. Do you find MSG to be an issue for you? It is huge for me even in the tiniest amount like a single Dorito or rice cooked in chicken broth, that is pretty much the only thing that has caused me any pain CD wise in the last two years, other things are just a major annoyance. I haven't been able to figure out if MSG is a yeast thing or unrelated.
Dx CD Oct '06 mom of 3 boys
Past Meds: prednisone, Lialda, Asacol, entocort, flagyl, cipro

big betty
Regular Member


Date Joined Nov 2010
Total Posts : 461
   Posted 5/1/2013 8:49 PM (GMT -6)   
I stay away from food ingredients that have a bad reputation like MSG, high fructose corn syrup and bad fats like trans fats. It just makes common sense that if they are bad for normal people they are not going to help us IBD folks much. Unfortunately some products that help normal people with digestion issues are made with yeasts and molds, beano, for example, and some digestive enzymes are as well. It helps to find out what all the ingredients are in every single thing, (but what a pain!).

MamaCof3
New Member


Date Joined May 2013
Total Posts : 8
   Posted 5/2/2013 3:56 PM (GMT -6)   
Does anyone know if prednisone can adversely affect the results of the IBD serology test from prometheus?

Ides
Forum Moderator


Date Joined Nov 2003
Total Posts : 6817
   Posted 5/2/2013 6:40 PM (GMT -6)   
I answered you on your other post - here: http://www.healingwell.com/community/default.aspx?f=17&m=1079862
Moderator Crohn's disease, Osteoarthritis and Irritable Bowel Forums

CD, Ankylosing Spondylitis, small fiber peripheral neuropathy, avascular necrosis, peripheral artery disease, pulmonary hypertension, degenerative disc disease, asthma, severe allergy and a host of other medical problems.
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