Age of Diagnosis Influences Serologic Responses in Children with Crohn's Disease: A Possible Clue to Etiology?

Background: Crohn's disease (CD) is often associated with antibodies to microbial antigens. Differences in immune response may offer clues to the pathogenesis of the disease. The aim was to examine the influence of age at diagnosis oil the serologic response in children with with CD. \ Methods: Data were drawn from 3 North American multicenter pediatric inflammatory bowel disease (IBD) research consortia. At or shortly after diagnosis. pANCA. ASCA IgA, ASCA IgG, anti- ompC, and anti-CBirl were assayed. The results were compared as a function of age at CD diagnosis (0-7 years versus 8-15 years). Results: In all, 705 children (79 <8 years of age at diagnosis, 626 >= 8 years) were studied. Small bowel CD was less frequent in the younger group (48.7% versus 72.6%; P < 0.0001), while colonic involvement was comparable (91.0% versus 86.5%). ASCA IgA and IgG were seen in <20% of those 0-7 years old compared to nearly 40% of those 8-15 years old (P < 0.001), while anti-CBirl was more frequent in the younger children (66% versus 54%, P < 0.05) Anti-CBirl detected a significant number of children in both age groups who otherwise were serologically negative. Both age at diagnosis and site of CD involvement were independently associated with expression of ASCA and anti-CBirl. Conclusions: Compared to children 8-15 years of age at diagnosis, those 0-7 years are more likely to express anti-CBirl but only half as likely to express ASCA. These age-associated differences in antimicrobial seropositivity suggest that there may lie different. and as yet unrecognized, genetic, immunologic, and/or micorbial factors leading to CD in the youngest children.