Inflammation in the proximal colon is a risk factor for the development of colorectal neoplasia in inflammatory bowel disease patients with primary sclerosing cholangitis.
Omar K Jamil, Dustin Shaw, Zifeng Deng, Nicholas Dinardi, Natalie Fillman, Shivani Khanna, Noa Krugliak Cleveland, Atsushi Sakuraba, Christopher R Weber, Russell D Cohen, Sushila Dalal, Bana Jabri, David T Rubin, Joel Pekow
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Abstract
Background: Patients with primary sclerosing cholangitis (PSC) and inflammatory bowel disease (IBD) have an increased risk of developing colorectal neoplasia (CRN) in the proximal colon.
Objectives: To evaluate whether duration and severity of inflammation are linked to the development of CRN in this population.
Design: Retrospective, case-control chart review of patients with PSC and IBD at a tertiary care center.
Methods: Disease activity was scored per colonic segment at each colonoscopy prior to the first instance of observed CRN using a modified Mayo endoscopic sub-score and histologic assessment. Patients in the CRN-positive group were compared to controls that did not.
Results: In all, 72 PSC-IBD patients with no history of CRN were identified, 13 of whom developed CRN after at least one colonoscopy at our institution. Patients in the CRN-positive group had significantly more endoscopic (p < 0.01) and histologic (p < 0.01) inflammation in the right compared to the control group prior to the development of dysplasia. There was significantly greater endoscopic inflammation in the segment of the colon with a dysplastic lesion than other segments of the colon (p = 0.018). Patients with moderate/severe lifetime endoscopic (p = 0.02) or histologic inflammation (p = 0.04) score had a lower probability of remaining free of dysplasia during follow-up. Nearly half of the patients with dysplasia had invisible lesions found on random biopsy.
Conclusions: Endoscopic and histologic inflammation in the proximal colon are risk factors for CRN in patients with PSC-IBD. PSC-IBD patients frequently have subclinical inflammation, and these findings support the practice of regular assessment of disease activity and random biopsy of inflamed and uninflamed areas in patients with PSC with the goal of reducing inflammation to prevent the development of CRN.
背景：原发性硬化性胆管炎（PSC）和炎症性肠病（IBD）患者在近端结肠发生结直肠肿瘤（CRN）的风险增加。目的：评估炎症的持续时间和严重程度是否与该人群CRN的发展有关。设计：对三级护理中心PSC和IBD患者进行回顾性病例对照表审查。方法：在首次观察到CRN之前，在每次结肠镜检查中，使用改良的Mayo内窥镜亚评分和组织学评估对每个结肠段的疾病活动性进行评分。将CRN阳性组的患者与没有CRN阳性的对照组进行比较。结果：总共确定了72名没有CRN病史的PSC-IBD患者，其中13人在我们机构至少一次结肠镜检查后出现CRN。CRN阳性组患者的内窥镜检查次数明显增多（p p p = 0.018）。患有中度/重度终身内窥镜的患者（p = 0.02）或组织学炎症（p = 0.04）评分具有在随访期间保持无发育不良的较低概率。近一半的发育不良患者在随机活检中发现了不可见的病变。结论：PSC-IBD患者结肠近端的内镜和组织学炎症是CRN的危险因素。PSC-IBD患者经常有亚临床炎症，这些发现支持对PSC患者的疾病活动性进行定期评估，并对炎症和非炎症区域进行随机活检，目的是减少炎症以防止CRN的发展。
期刊介绍：
Therapeutic Advances in Gastroenterology is an open access journal which delivers the highest quality peer-reviewed original research articles, reviews, and scholarly comment on pioneering efforts and innovative studies in the medical treatment of gastrointestinal and hepatic disorders. The journal has a strong clinical and pharmacological focus and is aimed at an international audience of clinicians and researchers in gastroenterology and related disciplines, providing an online forum for rapid dissemination of recent research and perspectives in this area.
The editors welcome original research articles across all areas of gastroenterology and hepatology.
The journal publishes original research articles and review articles primarily. Original research manuscripts may include laboratory, animal or human/clinical studies – all phases. Letters to the Editor and Case Reports will also be considered.
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