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Canadian Journal of Gastroenterology
Volume 11 (1997), Issue 8, Pages 689-693
Original Article

Atypical Perinuclear Antineutrophil Cytoplasmic Antibodies in Patients with Crohn’s Disease

Hugh J Freeman

Department of Medicine (Gastroenterology), University of British Columbia, Vancouver, British Columbia, Canada

Received 9 May 1997; Accepted 20 August 1997

Copyright © 1997 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Atypical perinuclear antineutrophil cytoplasmic antibodies (p-ANCA) occur in most patients with ulcerative colitis but only in a minority of those with Crohn's disease. In a recent study from the United States, this serological marker was reported to be present in 100% of Crohn's disease patients with a clinical phenotype of 'left-sided ulcerative colitis' but was not present in patients with 'isolated' small bowel disease. In a previously reported survey from the author's hospital, the p-ANCA status of 247 consecutive patients with Crohn's disease was evaluated, and, of these, 33 Crohn's disease patients were seropositive, including 18 (13.0%) with combined small and large bowel disease, 11 (19.6%) with 'isolated' colorectal disease, and four (4.6%) with 'isolated' small bowel but no detectable colorectal disease. To further evaluate and verify the significance of atypical p-ANCA in these 33 patients, clinical, radiological, endoscopic and histological features were examined. This study confirms that an 'ulcerative colitis-like' clinical phenotype may be seen in most, but not all, serologically positive Crohn's disease patients. Moreover, 'isolated' small bowel disease in the absence of colorectal disease occurs. Detection of atypical p-ANCA in Crohn's disease with different clinical and pathological features provides serological evidence that Crohn's disease is a very heterogeneous disorder.