Chronic liver disease promotes lesions of the colorectal adenoma‐carcinoma sequence, independent of liver cirrhosis

Abstract

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.

Inflammation, etiologies and Model for End‐stage Liver Disease score: What makes liver disease patients susceptible to developing colorectal neoplasia?

“…In total, we included 1046 patients in the present study, 407 with chronic liver disease and 639 without. The dataset was described in our previous study, and is summarized in Table . Etiologies that were analyzed separately include ALD, viral hepatitis, NAFLD, metabolic and cryptogenic hepatopathies, patients with more than one liver disease diagnosis, those with hepatocellular carcinoma (HCC), and others (autoimmune, cholestatic, cardiac, Budd–Chiari syndrome, tropical infections, or Churg–Strauss syndrome).…”

“…For our first analysis, we assessed links between colorectal neoplasia and MELD score or portal hypertension in multivariable logistic or ordinal regression models. As previously reported, we adjusted for factors known to influence the occurrence of polyps and adenomas: age, sex, number of colonoscopies, and BMI . We designed a cumulative marker for portal hypertension consisting of any hypertensive sign, including varices (esophageal, rectal), ascites, hypersplenism, and cutaneous signs.…”

“…In a previous study, we identified patients with chronic liver disease as a risk group for lesions of the colorectal adenoma‐carcinoma sequence . This opened up two subsequent fields of discussion: First, chronic liver disease is a heterogenous entity, necessitating substratification of patients according to risk of colorectal neoplasia.…”

“…Knowledge of causes may help improve screening and even allow prophylactic measures. To follow up on these questions, we obtained detailed data that we added to our previously reported database …”

“…3 In a previous study, we identified patients with chronic liver disease as a risk group for lesions of the colorectal adenoma-carcinoma sequence. 4 This opened up two subsequent fields of discussion: First, chronic liver disease is a heterogenous entity, necessitating substratification of patients according to risk of colorectal neoplasia. Second, underlying mechanisms linking chronic liver disease and colorectal neoplasia have never been investigated, and will be examined in this study for the first time.…”