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Can ASCA help differentiate Crohn's disease from H. pylori infection?

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

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Published At April 28, 2022
Reviewed AtSeptember 4, 2023

Patient's Query

Hello doctor,

I wanted a GI doctor's second opinion based on my history. My current GI doctor has worked me up with a colonoscopy, endoscopy, and blood and breath tests. For blood tests, I was found to have a positive ASCA (>50) and a negative pANCA. For breath tests, I had a negative H. pylori test. Based on colonoscopy, I was diagnosed with indeterminate colitis (IC). After the endoscopy, I was diagnosed with a chronic H. pylori infection. I wanted to ask whether the positive ASCA is enough to differentiate this into Crohn's disease (CD), and if that is the case, is treating the H. pylori an correct thing to do? Currently, my doctor plans to move forward, treating only the H. pylori infection with Protonix, Metronidazole, and another antibiotic (he was going to prescribe Doxycycline, but I am allergic). Any take on this situation? I currently have bright red bloody diarrhea mixed with constipation, multiple hemorrhoids that I have banded, and occasional nausea and vomiting (no blood in the vomit).

Also, I have lost forty pounds in the past four months (from 180 to 140 pounds), since the symptoms started. I have had the same symptoms almost ten years back, but were inconclusive.

Hi,

Welcome to icliniq.com.

I am sorry you have to suffer this way, Do not worry.

There are proper diagnostic criteria for Crohn's disease apart from the positive ASCA (anti-Saccharomyces cerevisiae antibodies). It does not just include antineutrophil cytoplasmic antibodies (ANCA). Since your colonoscopy did not have those features, it was diagnosed as non-specific colitis.

The right treatment approach is to treat H. pylori with Protonix (Pantoprazole), Metronidazole (antibiotic), and another antibiotic. Continue with the treatment for two weeks, and we will review it later. Weight loss is also expected in colitis. Do you have any other doubt?

Kindly share your colonoscopy films; I will review them.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Navajith A. Mani
Dr. Navajith A. Mani

General Practitioner

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