Background Research increasingly focuses on identifying individuals at greater risk of colorectal cancer (CRC) to enhance colonoscopy screening efficacy. Objective The objective of this article is to determine associations between chronic liver disease and lesions along the colorectal adenoma-carcinoma sequence. Methods This retrospective study encompasses consecutive liver disease patients (LDPs) of all etiologies evaluated for liver transplantation at a single institution and a control group of liver-healthy patients (LHPs) undergoing colonoscopy as part of the German CRC screening program. Rates of polyps, adenomas, high-risk situations (HRS) and CRC were analyzed in univariable and multivariable settings adjusting for age, gender, body mass index and number of colonoscopies. Differences between LHPs and LDPs and between cirrhotic and noncirrhotic hepatopathy were assessed. Results In total, 1046 patients (52.6% male, median age 59.6 years) were included, of whom 38.9% had liver disease. A total of 41.0% of all patients showed polyps, 23.2% adenomas, 10.0% HRS, and 0.5% CRC. LDPs were more likely to develop polyps, adenomas and HRS than LHPs, both in univariable and multivariable analysis. There were no significant differences between cirrhotic and noncirrhotic patients. Conclusion Chronic liver disease of any etiology is associated with colonic lesions of the colorectal adenoma-carcinoma sequence, independent of cirrhosis. LDPs should receive intensified, and earlier, colonoscopy screening.
Aim Research has identified patients with chronic liver disease as a risk group for colorectal neoplasia. In this study, we aimed to identify liver disease subgroups at enhanced risk of developing colorectal neoplasia, as well as causal factors. Methods The present retrospective study included patients with chronic liver disease undergoing colonoscopy during liver transplantation evaluations, and liver‐healthy patients as part of the German screening protocol. We assessed inflammatory laboratory values, Model for End‐stage Liver Disease score, portal hypertension, and liver disease etiologies as explanatory variables. Outcomes included polyps, adenomas, high‐risk situations, and colorectal cancer, tested in uni‐ and multivariable analyses. Results A total of 1046 patients were included, 407 with liver disease, 639 without. Alcohol‐toxic, metabolic, cryptogenic, non‐alcoholic fatty liver disease, and hepatocellular carcinoma were significantly associated with colorectal neoplasia, as were low compared with high Model for End‐stage Liver Disease scores. Portal hypertension showed no associations with neoplasia. Inflammatory markers were associated with colorectal neoplasia, independent of liver disease severity. Conclusions Low Model for End‐stage Liver Disease score, inflammatory markers, and certain etiologies were associated with colorectal neoplasia. Our findings suggest that inflammation may play an important role in the development of colonic adenomas in patients with chronic liver disease. Findings need to be confirmed in prospective studies, but may allow risk stratification and, possibly, development of prophylactic treatments.
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