[Antiphospholipid antibodies in digestive diseases]

DIAGNOSIS AND PROGNOSIS: Antiphospholipids comprise a very heterogeneous group of auto-antibodies including anticardiolipids demonstrated by immunological methods and lupus anticoagulants detected by coagulation tests. Antiphospholipids are encountered in various conditions other than dysimmune disease and are frequently involved in thrombotic manifestations. We discuss here the implications of these antibodies in digestive tract diseases and present an analysis of their diagnostic and prognostic value for optimal therapeutic and monitoring approaches.

The risk of thrombosis is high in patients with cryptogenetic inflammatory bowel disease. The prevalence of antiphospholipid antibodies (AcAPL) is abnormally high in these patients, but their contribution to the development of thrombosis remains controversial. Patients with liver disease generally exhibit coagulation disorders, with paradoxical thrombotic manifestations. AcAPL are strongly implicated in the development of thrombosis, particularly in patients with alcoholic liver disease, hepatitis C, regenerative nodular hyperplasia, and cirrhosis, independently of the presence of an associated hepatocellular carcinoma. Antiphospholipid syndrome is considered to be the second leading cause of non-tumor-related Budd-Chiari syndrome, after myeproliferative syndromes. Likewise for portal or mesenteric vein thrombosis where antiphospholipid antibodies would be involved in the causal mechanism.

Due to the diversity of these antibodies, it is unlikely that a unique mechanism could explain all the different thrombotic manifestations associated with their presence.