Investigation of C4D staining pattern with clinical findings in inflammatory bowel diseases

Objectives: Inflammatory bowel disease (IBD) is a chronic disease with clinical remission and exacerbations. The biggest problem for the clinician regarding the disease course is to estimate the activation frequency and to choose the optimal drug accordingly. In this study, the results obtained with the C4d complement dye of the pathological material at the time of the first diagnosis of the disease; disease activity, the need for surgery in the later stages of patients, the necessity of using Tumor necrosis factor alpha inhibitör(anti-TNF) drugs, the development of fistula or perianal disease and the presence of complications developing outside the intestine were investigated. Thus, according to the pattern and involvement of the staining, it is aimed that the results will be guiding in the early stages of transition to upper-level treatments. Material and Method: This study included 100 patients with IBD between the ages of 22-81 (42 women, 58 men, 49 Crohn's disease (CH), 51 ulcerative colitis (UC)). Patients were diagnosed with IBD according to the European Crohn's and Colitis Organization (ECCO) Guidelines, by evaluating all clinical, endoscopy, radiological and histopathological examination findings. Harvey Bradshaw Index (remission≤4) was used to evaluate the clinical activity of CH and Modified Mayo Scoring (remission≤2) was used to evaluate the clinical activity of UC. Pathological materials of all patients at the time of initial diagnosis were simultaneously painted with C4d complement dye and compared with the clinical and demographic findings of patients obtained from the hospital registry system. Results: While 12 (52.17%) of ulcerative colitis patients had positive results with C4d complement dye, 11 of Crohn's patients (47.83%) had staining. The presence of C4d complement staining was observed in 8 patients with 26 active diseases in ulcerative colitis (p = 0.214). This staining pattern is statistically significant between the need for anti-TNF drug use in the future (p = 0.237), fistula / perianal disease development (p = 0.765), the need for surgical intervention (p = 0.581) and more often extra-intestinal involvement (p = 0.185). no significant relationship was seen. Similarly, C4d positivity was observed in the staining of 8 patients in 26 active Crohn patients (p = 0.214). C4d with the need for surgical intervention in patients (p = 0.173), fistula or perianal disease (p = 0.633), tumor necrosis factor alpha inhibitor (anti-TNF) drug requirement (p = 0.408), extra-intestinal complications (p = 0.357) There was no statistically significant relationship between dye involvement. Conculusion: There was no statistically significant relationship between disease activity of C4d staining pattern, need for surgical operation due to IBD, anti TNF drug requirement, development of fistula or perianal disease and extraintestinal involvement in IBD patients. Especially the relationship between clinical activity scores and this staining pattern should be evaluated in studies with larger patient groups.