PERINUCLEAR ANTINEUTROPHIL CYTOPLASMIC ANTIBODIES IN COLLAGENOUS OR LYMPHOCYTIC COLITIS WITH OR WITHOUT CELIAC-DISEASE

Microscopic forms of colitis, including lymphocytic and collagenous co litis, have been observed in both those with and without celiac diseas e. Although perinuclear antineutrophil cytoplasmic antibodies (p-ANCA) occur in most patients with ulcerative colitis, investigations in mic roscopic, particularly lymphocytic, colitis are still needed. In this study atypical p-ANCA was evaluated in 55 patients, including 27 with celiac disease alone, 13 with celiac disease and concomitant lymphocyt ic colitis, and 15 with microscopic forms of colitis, including lympho cytic and collagenous colitis. Nine patients (16.3%) had atypical p-AN CA, including six with celiac disease and three with a microscopic for m of colitis alone. Although five of the six positive celiac disease p atients had lymphocytic colitis, all three celiac disease patients wit h associated primary sclerosing cholangitis-a separate risk factor for a positive assay result-were serologically positive for atypical p-AN CA. These results indicate for the first time that this serological ma rker may occur in histologically defined celiac disease with or withou t concomitant lymphocytic colitis. Furthermore, these results suggest that the pathogenesis of ulcerative colitis differs from that of lymph ocytic colitis and further emphasizes the heterogeneous nature of thes e newly recognized types of colonic inflammatory mucosal disorders.