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P077. Diagnostic utility of anti-Saccharomyces cerevisiae antibody (ASCA) and interferon-gamma assay in the differential diagnosis of Crohn's disease and intestinal tuberculosis

P077. Diagnostic utility of anti-Saccharomyces cerevisiae antibody (ASCA) and interferon-gamma assay in the differential diagnosis of Crohn's disease and intestinal tuberculosis

Y. Kim1, B. Kim2, Y. Kim2, W. Kim1, W. Kim3, J. Kim4, Y. Park5, S. Yang6, B. Ye6, B. Jang7, S. Jung8, Y. Jeen9, Y. Choi10, J. Choi11, C. Choi12, J. Cheon3, D. Han13

1Seoul Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea; 2Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; 3Yonsei University College of Medicine, Seoul, Republic of Korea; 4Seoul National University College of Medicine, Seoul, Republic of Korea; 5Eulji University College of Medicine, Seoul, Republic of Korea; 6University of Ulsan College of Medicine, Seoul, Republic of Korea; 7Yeungnam University College of Medicine, Daegu, Republic of Korea; 8Ewha Womans University School of Medicine, Seoul, Republic of Korea; 9Korea University College of Medicine, Seoul, Republic of Korea; 10DaeHang Hospital, Seoul, Republic of Korea; 11Korea University College of Medicine, Seoul, Republic of Korea; 12Chung-Ang University College of Medicine, Seoul, Republic of Korea; 13Hanyang University College of Medicine, Seoul, Republic of Korea

Aim: Differential diagnosis of Crohn's disease (CD) from intestinal tuberculosis (ITB) is challenging. Anti-Saccharomyces cerevisiae antibody (ASCA) is a specific serological marker for CD and may help differentiate CD from ITB. Recently, INF-gamma assay (QuantiFERON-TB gold test, QFT) is regarded as a useful diagnostic aid in the diagnosis of ITB. We evaluated the clinical usefulness of ASCA and QFT test for differential diagnosis of ITB from CD in Korean adults.

Materials and Methods: A total of 147 patients suspected to have ITB or CD was prospectively enrolled from 13 Korean hospitals. ASCA IgG serum titers were measured by ELISA, and the QFT test was also performed.

Results: Thirty-one of 72 (43.6%) patients with CD were ASCA positive (titer >25 U) compared to 7 of 75 ITB patients (9.3%) and 2 of 20 healthy controls (10%) (P < 0.01). The QFT test was positive in 7 patients with CD (9.7%) and 50 patients with ITB (66.6%) (P < 0.01). In cases which ASCA positive/QFT negative, the sensitivity, specificity, positive predictive value, and negative predictive value for the diagnosis of CD was 43.05%, 96.0%, 91.18%, and 63.72%, respectively. The positive likelihood ratio (LR+) of these test results for the diagnosis of CD was 10.76. In contrast, in cases in which ASCA negative/QFT positive, the sensitivity, specificity, PPV, and NPV for the diagnosis of ITB was 60%, 91.67%, 88.24%, and 68.75%, respectively. The LR+ of these test results for the diagnosis of ITB was 7.2.

Conclusions: ASCA is a useful diagnostic tool for CD in Korea, where ITB is prevalent. In particular, when ASCA is combined with QFT, effective differential diagnosis of CD from ITB is possible.