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Background and Aims  The identification of Crohn's disease (CD)‐associated adherent and invasive  Escherichia coli  (AIEC) is time‐consuming and requires ileal biopsies. We aimed to identify a faster and less invasive methods to detect ileal colonization by AIEC in CD patients.    Methods  CD patients requiring ileo‐colonoscopy were consecutively enrolled in this prospective multicenter study. Samples from saliva, serum, stools, and ileal biopsies of CD patients were collected.    Results  Among 102 CD patients, the prevalence of AIEC on ileal biopsies was 24.5%. The abundance and global invasive ability of ileal‐associated total  E. coli  were respectively ten‐fold ( p  = 0.0065) and two‐fold ( p  = 0.0007) higher in AIEC‐positive (vs. AIEC‐negative), while abundance of total  E. coli  in the feces was not correlated with AIEC status in the ileum. The best threshold of ileal total  E. coli  was 60 cfu/biopsy to detect AIEC‐positive patients, with high negative predictive value (NPV) (94.1%[80.3–99.3]), while the global invasive ability (>9000 internalized bacteria) was able to detect the presence of AIEC with high positive predictive value (80.0% [55.2–100.0]). Overall, 78.1% of the AIEC + patients were colonized by two or less different AIEC strains. The level of serum anti‐total  E. coli  antibodies (AEcAb) was higher in AIEC‐positive patients ( p  = 0.038) with a very high negative predictive value (96.6% [89.9–100.0]) ( p  = 0.038) for a cut‐off value > 1.9 × 10 −3 .    Conclusions  More than two thirds of AIEC‐positive CD patients were colonized by two or less AIEC strains. While stools samples are not accurate to screen AIEC status, the AEcAb level appears to be an attractive, rapid and easier biomarker to identify patients with Crohn's disease harboring AIEC.

Faster and less invasive tools to identify patients with ileal colonization by adherent‐invasive E. coli in Crohn's disease