infection can complicate pouchitis in patients with an ileal pouch-anal anastomosis and should be considered in patients who fail to respond to standard treatment, including metronidazole. In cases of refractory pouchitis, superadded infection with should be excluded before initiation of potent anti-inflammatory drugs.

As UK medical students, we recently completed 3 months of remote learning due to the COVID-19 pandemic, before taking online end-of-the-year exams. We are now entering our final year of medical school. Based on our experiences and our understanding of others’ experiences, we believe that three key lessons have been universal for medical students around the world. The lessons learned throughout this process address the need for a fair system for medical students, the importance of adaptability in all aspects of medical education, and the value of a strong medical school community. These lessons can be applied in the years to come to improve medical education as we know it.

INTRODUCTION: There is increased risk of several malignancies in inflammatory bowel disease (IBD). However, evidence regarding risk of cervical cancer in IBD is conflicting. We aimed to investigate the risk of cervical cancer in IBD by undertaking a systematic review and meta-analysis of unselected, population-based studies. METHODS: MEDLINE, EMBASE, and Cochrane Library were searched using Medical Subject Heading terms, and 2 reviewers independently screened results. Pooled hazard ratios (HRs) were calculated using random effects model meta-analysis for risk of cervical cancer in IBD. Subgroup meta-analysis was undertaken to assess risk of cervical cancer by IBD subtype (Crohn's disease and ulcerative colitis), treatment exposure, and grade of lesion. RESULTS: We screened 1,393 articles to identify 5 population-based studies, including 74,310 patients with IBD and 2,029,087 reference patients, across 5 different countries. Pooled random effects model meta-analysis of these studies did not show statistically significant increased risk for cervical cancer in IBD compared with reference populations (HR: 1.24; 95% confidence interval [CI]: 0.94–1.63). Meta-analysis by grade of lesion showed increased risk of low-grade cervical lesions (HR: 1.15; 95% CI: 1.04–1.28). Meta-analysis by disease subtype indicated no statistically significant increased risk in Crohn's disease (HR: 1.36; 95% CI: 0.83–2.23) or ulcerative colitis (HR: 0.95; 95% CI: 0.72–1.25) or in patients treated with antitumor necrosis factor (HR: 1.19; 95% CI: 0.64–2.21) or thiopurines (HR: 0.96; 95% CI: 0.60–1.50). DISCUSSION: This meta-analysis of high-quality, unselected population-based studies shows no statistically significant increased risk of cervical cancer in patients with IBD. There is, however, increased risk of low-grade cervical lesions compared with the general population.

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