Distribution of food specific antibodies in patients with inflammatory bowel disease / 中华消化杂志

ABSTRACT

Objective To investigate the incidence of food intolerance in patients with inflammatory bowel disease (IBD) and to analyze the differential diagnostic value of intolerant food in Crohn 's disease (CD) and ulcerative colitis (UC) and its effects on the diseases.Methods From January 2017 to June 2018, at Department of Gastroenterology and Hepatology , Jinling Hospital, Medical School of Nanjing University /General Hospital of Eastern Theater Command , PLA, a total of 252 IBD (154 CD and 98 UC) patients were enrolled. In the same period 46 non-IBD patients were recruited.Allergic diseases were excluded.The food-specific IgG antibodies were detected by enzyme linked immunosorbent assay (ELISA) in all enrolled patients.The chi-square test, Kruskal-Wallis test and Spearman correlation analysis were performed for statistical analysis . Regression analysis was used to screen the risk factors .Results The total positive rates of serum IgG antibody of corn, rice, soybean, tomato and wheat in CD patients were 60.4％ (93 /154), 57.8％ (89 /154), 42.9％(66 /154), 68.2％ (105 /154) and 19.5％ (30 /154),respectively, which were higher than those in patients with UC (7.1％, 7 /98; 5.1％, 5 /98; 5.1％,5 /98; 16.3％, 16 /98 and 3.1％, 3 /98, respectively) and those of non-IBD patients (2.2％,1 /46; 2.2％,1/46; 0,0 /46; 0,0 /46 and 0,0/46, respectively), and the differences were statistically significant (χ2 =70.940,71.092,42.185,64.517,14.187;48.190,44.270, 29.424,66.029,10.542; all P <0.01).The total number of positive food related IgG antibodies had strong ability to discriminate CD, UC from non-IBD, the value of area under the curve (AUC) was 0.815 (95％confidence interval (CI) 0.762 to 0.869, P <0.01)and 0.824(95％CI 0.767 to 0.880,P <0.01).There was no correlation between the total number of IgG positive food and age in CD patients (P >0.05) and there was a negative correlation between the total number of IgG positive food and age in UC patients (rs =-0.376, P <0.01).The median number of total IgG positive food of patients with lesions involving the terminal ileum (L1) and ileocolon (L3) was two and four, respectively, and the difference was statistically significant (the statistic was 11.717,P =0.002).The median number of total IgG positive food of UC patients with rectal lesions (E1) and extensive colon lesions (E3) was zero and one, respectively, and the difference was statistically significant (the statistic was 7.191,P =0.022).In addition, positive IgG shrimp and soybean were risk factors of CD patients combined with extra-intestinal manifestations and low body mass index (odd ratio (OR) =24.558, 95％CI 2.243 to 268.936; OR =2.253, 95％ CI 1.048 to 4.841; both P <0.05, respectively ). Conclusions CD patients are more susceptible to food intolerance .The number of intolerant foods have differential diagnostic value in CD, UC and non-IBD.The larger the lesion of IBD patients, the more common the food intolerance.IgG antibody positive food positive, may affect extra-intestinal manifestations and nutritional status of CD patients .