High risk of advanced colorectal neoplasia in patients with primary sclerosing cholangitis associated with inflammatory bowel disease
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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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Chronic inflammation in IBD is associated with increased risk for colorectal malignancy.
“Also, chronic inflammation in IBD is associated with increased risk for colorectal malignancy.359,[369][370][371]”
From EASL Clinical Practice Guidelines on sclerosing cholangitis (2022) · cites this paper as [370]
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- Authors
- Shah, S. C., ten Hove, J. R., Castaneda, D., Palmela, C., Mooiweer, E., Colombel, J.-F., Harpaz, N., Ullman, T. A., van Bodegraven, A. A., Jansen, J. M., Mahmmod, N., van der Meulen-de Jong, A. E., Ponsioen, C. Y., van der Woude, C. J., Oldenburg, B., Itzkowitz, S. H., & Torres, J.
- Affiliations
- Vanderbilt University Medical Center (US)
- Icahn School of Medicine at Mount Sinai (US)
- University Medical Center Utrecht (NL)
- OLVG (NL)
- St. Antonius Ziekenhuis (NL)
- Amsterdam UMC Location University of Amsterdam (NL)
- Hospital Beatriz Ângelo (PT)
- Corresponding author
- Torres, Joana
- ORCID
- Venue
- Clinical Gastroenterology and Hepatology
- Publisher
- Elsevier BV
- Published
- 2018-07
- Volume
- 16
- Issue
- 7
- Pages
- 1106-1113.e3
- ISSN
- 1542-3565 (ISSN-L)
- OpenAlex
- W2786161279
- Cited by
- 109
- References
- 43
- Citations by year
- 2026: 4 · 2025: 19 · 2024: 10 · 2023: 17 · 2022: 12 · 2021: 11 · 2020: 18 · 2019: 13 · 2018: 5
- FWCI
- 4.41
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Clinical Gastroenterology and Hepatology (publishedVersion)
- PubMed (publishedVersion)
- Leiden Repository (Leiden University) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
- Pure Amsterdam UMC (submittedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (submittedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (P30DK058404)
- Topics
- Health Sciences › Medicine › Oncology › Colorectal Cancer Screening and Detection
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Inflammatory Bowel Disease
- Health Sciences › Medicine › Pathology and Forensic Medicine › Genetic factors in colorectal cancer
- Keywords
- primary sclerosing cholangitis, inflammatory bowel disease, advanced colorectal neoplasia, colorectal cancer, low-grade dysplasia, high-grade dysplasia, colonic dysplasia, colonic inflammation, surveillance colonoscopy, risk factors, colitis-associated colorectal cancer, Crohn's disease, ulcerative colitis, sex differences, alcohol consumption
- MeSH terms
- Adolescent, Adult, Colonoscopy, Female, Histocytochemistry, Humans, Longitudinal Studies, Male, Middle Aged, Netherlands, Retrospective Studies, United States, Colorectal Neoplasms, Cholangitis, Sclerosing, Inflammatory Bowel Diseases, Risk Assessment, Young Adult
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