High Risk of Advanced Colorectal Neoplasia in Patients With Primary Sclerosing Cholangitis Associated With Inflammatory Bowel Disease

Shailja C. Shah, Joren R. ten Hove, Daniel Castaneda, Carolina Palmela, Erik Mooiweer, Jean Frédéric Colombel, Noam Harpaz, Thomas A. Ullman, Ad A. van Bodegraven, Jeroen M. Jansen, Nofel Mahmmod, Andrea E. van der Meulen-de Jong, Cyriel Y. Ponsioen, Christine J. van der Woude, Bas Oldenburg, Steven H. Itzkowitz, Joana Torres

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background & Aims: Patients with inflammatory bowel disease (IBD) and primary sclerosing cholangitis (PSC, termed PSC-IBD) are at increased risk for colorectal cancer, but their risk following a diagnosis of low-grade dysplasia (LGD) is not well described. We aimed to determine the rate of advanced colorectal neoplasia (aCRN), defined as high-grade dysplasia and/or colorectal cancer, following a diagnosis of indefinite dysplasia or LGD in this population. Methods: We performed a retrospective, longitudinal study of 1911 patients with colonic IBD (293 with PSC and 1618 without PSC) who underwent more than 2 surveillance colonoscopies from 2000 through 2015 in The Netherlands or the United States (9265 patient-years of follow-up evaluation). We collected data on clinical and demographic features of patients, as well as data from each surveillance colonoscopy and histologic report. For each surveillance colonoscopy, the severity of active inflammation was documented. The primary outcome was a diagnosis of aCRN during follow-up evaluation. We also investigated factors associated with aCRN in patients with or without a prior diagnosis of indefinite dysplasia or LGD. Results: Patients with PSC-IBD had a 2-fold higher risk of developing aCRN than patients with non-PSC IBD. Mean inflammation scores did not differ significantly between patients with PSC-IBD (0.55) vs patients with non-PSC IBD (0.56) (P =.89), nor did proportions of patients with LGD (21% of patients with PSC-IBD vs 18% of patients with non-PSC IBD) differ significantly (P =.37). However, the rate of aCRN following a diagnosis of LGD was significantly higher in patients with PSC-IBD (8.4 per 100 patient-years) than patients with non-PSC IBD (3.0 per 100 patient-years; P =.01). PSC (adjusted hazard ratio [aHR], 2.01; 95% CI, 1.09–3.71), increasing age (aHR 1.03; 95% CI, 1.01–1.05), and active inflammation (aHR, 2.39; 95% CI, 1.63–3.49) were independent risk factors for aCRN. Dysplasia was more often endoscopically invisible in patients with PSC-IBD than in patients with non-PSC IBD. Conclusions: In a longitudinal study of almost 2000 patients with colonic IBD, PSC remained a strong independent risk factor for aCRN. Once LGD is detected, aCRN develops at a higher rate in patients with PSC and is more often endoscopically invisible than in patients with only IBD. Our findings support recommendations for careful annual colonoscopic surveillance for patients with IBD and PSC, and consideration of colectomy once LGD is detected.

Original languageEnglish (US)
Pages (from-to)1106-1113.e3
JournalClinical Gastroenterology and Hepatology
Volume16
Issue number7
DOIs
StatePublished - Jul 1 2018
Externally publishedYes

Fingerprint

Sclerosing Cholangitis
Inflammatory Bowel Diseases
Neoplasms
Colonoscopy
Inflammation
Longitudinal Studies
Colorectal Neoplasms

Keywords

  • Colon Cancer
  • Crohn's Disease
  • Primary Sclerosing Cholangitis
  • Surveillance
  • Ulcerative Colitis

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

High Risk of Advanced Colorectal Neoplasia in Patients With Primary Sclerosing Cholangitis Associated With Inflammatory Bowel Disease. / Shah, Shailja C.; ten Hove, Joren R.; Castaneda, Daniel; Palmela, Carolina; Mooiweer, Erik; Colombel, Jean Frédéric; Harpaz, Noam; Ullman, Thomas A.; van Bodegraven, Ad A.; Jansen, Jeroen M.; Mahmmod, Nofel; van der Meulen-de Jong, Andrea E.; Ponsioen, Cyriel Y.; van der Woude, Christine J.; Oldenburg, Bas; Itzkowitz, Steven H.; Torres, Joana.

In: Clinical Gastroenterology and Hepatology, Vol. 16, No. 7, 01.07.2018, p. 1106-1113.e3.

Research output: Contribution to journalArticle

Shah, SC, ten Hove, JR, Castaneda, D, Palmela, C, Mooiweer, E, Colombel, JF, Harpaz, N, Ullman, TA, van Bodegraven, AA, Jansen, JM, Mahmmod, N, van der Meulen-de Jong, AE, Ponsioen, CY, van der Woude, CJ, Oldenburg, B, Itzkowitz, SH & Torres, J 2018, 'High Risk of Advanced Colorectal Neoplasia in Patients With Primary Sclerosing Cholangitis Associated With Inflammatory Bowel Disease', Clinical Gastroenterology and Hepatology, vol. 16, no. 7, pp. 1106-1113.e3. https://doi.org/10.1016/j.cgh.2018.01.023
Shah, Shailja C. ; ten Hove, Joren R. ; Castaneda, Daniel ; Palmela, Carolina ; Mooiweer, Erik ; Colombel, Jean Frédéric ; Harpaz, Noam ; Ullman, Thomas A. ; van Bodegraven, Ad A. ; Jansen, Jeroen M. ; Mahmmod, Nofel ; van der Meulen-de Jong, Andrea E. ; Ponsioen, Cyriel Y. ; van der Woude, Christine J. ; Oldenburg, Bas ; Itzkowitz, Steven H. ; Torres, Joana. / High Risk of Advanced Colorectal Neoplasia in Patients With Primary Sclerosing Cholangitis Associated With Inflammatory Bowel Disease. In: Clinical Gastroenterology and Hepatology. 2018 ; Vol. 16, No. 7. pp. 1106-1113.e3.
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abstract = "Background & Aims: Patients with inflammatory bowel disease (IBD) and primary sclerosing cholangitis (PSC, termed PSC-IBD) are at increased risk for colorectal cancer, but their risk following a diagnosis of low-grade dysplasia (LGD) is not well described. We aimed to determine the rate of advanced colorectal neoplasia (aCRN), defined as high-grade dysplasia and/or colorectal cancer, following a diagnosis of indefinite dysplasia or LGD in this population. Methods: We performed a retrospective, longitudinal study of 1911 patients with colonic IBD (293 with PSC and 1618 without PSC) who underwent more than 2 surveillance colonoscopies from 2000 through 2015 in The Netherlands or the United States (9265 patient-years of follow-up evaluation). We collected data on clinical and demographic features of patients, as well as data from each surveillance colonoscopy and histologic report. For each surveillance colonoscopy, the severity of active inflammation was documented. The primary outcome was a diagnosis of aCRN during follow-up evaluation. We also investigated factors associated with aCRN in patients with or without a prior diagnosis of indefinite dysplasia or LGD. Results: Patients with PSC-IBD had a 2-fold higher risk of developing aCRN than patients with non-PSC IBD. Mean inflammation scores did not differ significantly between patients with PSC-IBD (0.55) vs patients with non-PSC IBD (0.56) (P =.89), nor did proportions of patients with LGD (21{\%} of patients with PSC-IBD vs 18{\%} of patients with non-PSC IBD) differ significantly (P =.37). However, the rate of aCRN following a diagnosis of LGD was significantly higher in patients with PSC-IBD (8.4 per 100 patient-years) than patients with non-PSC IBD (3.0 per 100 patient-years; P =.01). PSC (adjusted hazard ratio [aHR], 2.01; 95{\%} CI, 1.09–3.71), increasing age (aHR 1.03; 95{\%} CI, 1.01–1.05), and active inflammation (aHR, 2.39; 95{\%} CI, 1.63–3.49) were independent risk factors for aCRN. Dysplasia was more often endoscopically invisible in patients with PSC-IBD than in patients with non-PSC IBD. Conclusions: In a longitudinal study of almost 2000 patients with colonic IBD, PSC remained a strong independent risk factor for aCRN. Once LGD is detected, aCRN develops at a higher rate in patients with PSC and is more often endoscopically invisible than in patients with only IBD. Our findings support recommendations for careful annual colonoscopic surveillance for patients with IBD and PSC, and consideration of colectomy once LGD is detected.",
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author = "Shah, {Shailja C.} and {ten Hove}, {Joren R.} and Daniel Castaneda and Carolina Palmela and Erik Mooiweer and Colombel, {Jean Fr{\'e}d{\'e}ric} and Noam Harpaz and Ullman, {Thomas A.} and {van Bodegraven}, {Ad A.} and Jansen, {Jeroen M.} and Nofel Mahmmod and {van der Meulen-de Jong}, {Andrea E.} and Ponsioen, {Cyriel Y.} and {van der Woude}, {Christine J.} and Bas Oldenburg and Itzkowitz, {Steven H.} and Joana Torres",
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TY - JOUR

T1 - High Risk of Advanced Colorectal Neoplasia in Patients With Primary Sclerosing Cholangitis Associated With Inflammatory Bowel Disease

AU - Shah, Shailja C.

AU - ten Hove, Joren R.

AU - Castaneda, Daniel

AU - Palmela, Carolina

AU - Mooiweer, Erik

AU - Colombel, Jean Frédéric

AU - Harpaz, Noam

AU - Ullman, Thomas A.

AU - van Bodegraven, Ad A.

AU - Jansen, Jeroen M.

AU - Mahmmod, Nofel

AU - van der Meulen-de Jong, Andrea E.

AU - Ponsioen, Cyriel Y.

AU - van der Woude, Christine J.

AU - Oldenburg, Bas

AU - Itzkowitz, Steven H.

AU - Torres, Joana

PY - 2018/7/1

Y1 - 2018/7/1

N2 - Background & Aims: Patients with inflammatory bowel disease (IBD) and primary sclerosing cholangitis (PSC, termed PSC-IBD) are at increased risk for colorectal cancer, but their risk following a diagnosis of low-grade dysplasia (LGD) is not well described. We aimed to determine the rate of advanced colorectal neoplasia (aCRN), defined as high-grade dysplasia and/or colorectal cancer, following a diagnosis of indefinite dysplasia or LGD in this population. Methods: We performed a retrospective, longitudinal study of 1911 patients with colonic IBD (293 with PSC and 1618 without PSC) who underwent more than 2 surveillance colonoscopies from 2000 through 2015 in The Netherlands or the United States (9265 patient-years of follow-up evaluation). We collected data on clinical and demographic features of patients, as well as data from each surveillance colonoscopy and histologic report. For each surveillance colonoscopy, the severity of active inflammation was documented. The primary outcome was a diagnosis of aCRN during follow-up evaluation. We also investigated factors associated with aCRN in patients with or without a prior diagnosis of indefinite dysplasia or LGD. Results: Patients with PSC-IBD had a 2-fold higher risk of developing aCRN than patients with non-PSC IBD. Mean inflammation scores did not differ significantly between patients with PSC-IBD (0.55) vs patients with non-PSC IBD (0.56) (P =.89), nor did proportions of patients with LGD (21% of patients with PSC-IBD vs 18% of patients with non-PSC IBD) differ significantly (P =.37). However, the rate of aCRN following a diagnosis of LGD was significantly higher in patients with PSC-IBD (8.4 per 100 patient-years) than patients with non-PSC IBD (3.0 per 100 patient-years; P =.01). PSC (adjusted hazard ratio [aHR], 2.01; 95% CI, 1.09–3.71), increasing age (aHR 1.03; 95% CI, 1.01–1.05), and active inflammation (aHR, 2.39; 95% CI, 1.63–3.49) were independent risk factors for aCRN. Dysplasia was more often endoscopically invisible in patients with PSC-IBD than in patients with non-PSC IBD. Conclusions: In a longitudinal study of almost 2000 patients with colonic IBD, PSC remained a strong independent risk factor for aCRN. Once LGD is detected, aCRN develops at a higher rate in patients with PSC and is more often endoscopically invisible than in patients with only IBD. Our findings support recommendations for careful annual colonoscopic surveillance for patients with IBD and PSC, and consideration of colectomy once LGD is detected.

AB - Background & Aims: Patients with inflammatory bowel disease (IBD) and primary sclerosing cholangitis (PSC, termed PSC-IBD) are at increased risk for colorectal cancer, but their risk following a diagnosis of low-grade dysplasia (LGD) is not well described. We aimed to determine the rate of advanced colorectal neoplasia (aCRN), defined as high-grade dysplasia and/or colorectal cancer, following a diagnosis of indefinite dysplasia or LGD in this population. Methods: We performed a retrospective, longitudinal study of 1911 patients with colonic IBD (293 with PSC and 1618 without PSC) who underwent more than 2 surveillance colonoscopies from 2000 through 2015 in The Netherlands or the United States (9265 patient-years of follow-up evaluation). We collected data on clinical and demographic features of patients, as well as data from each surveillance colonoscopy and histologic report. For each surveillance colonoscopy, the severity of active inflammation was documented. The primary outcome was a diagnosis of aCRN during follow-up evaluation. We also investigated factors associated with aCRN in patients with or without a prior diagnosis of indefinite dysplasia or LGD. Results: Patients with PSC-IBD had a 2-fold higher risk of developing aCRN than patients with non-PSC IBD. Mean inflammation scores did not differ significantly between patients with PSC-IBD (0.55) vs patients with non-PSC IBD (0.56) (P =.89), nor did proportions of patients with LGD (21% of patients with PSC-IBD vs 18% of patients with non-PSC IBD) differ significantly (P =.37). However, the rate of aCRN following a diagnosis of LGD was significantly higher in patients with PSC-IBD (8.4 per 100 patient-years) than patients with non-PSC IBD (3.0 per 100 patient-years; P =.01). PSC (adjusted hazard ratio [aHR], 2.01; 95% CI, 1.09–3.71), increasing age (aHR 1.03; 95% CI, 1.01–1.05), and active inflammation (aHR, 2.39; 95% CI, 1.63–3.49) were independent risk factors for aCRN. Dysplasia was more often endoscopically invisible in patients with PSC-IBD than in patients with non-PSC IBD. Conclusions: In a longitudinal study of almost 2000 patients with colonic IBD, PSC remained a strong independent risk factor for aCRN. Once LGD is detected, aCRN develops at a higher rate in patients with PSC and is more often endoscopically invisible than in patients with only IBD. Our findings support recommendations for careful annual colonoscopic surveillance for patients with IBD and PSC, and consideration of colectomy once LGD is detected.

KW - Colon Cancer

KW - Crohn's Disease

KW - Primary Sclerosing Cholangitis

KW - Surveillance

KW - Ulcerative Colitis

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