Neoplastic and other complications of inflammatory bowel disease

Abstract

Patients with inflammatory bowel disease (IBD) have long been known to be at increased risk of development of colorectal cancer; however, there are many nuances to cancer prevention strategies in IBD that remain unresolved. During the past year, two publications reported on the resection of otherwise typical adenoma-like masses by means of polypectomy, after which these patients were followed with continued endoscopic surveillance, rather than pursuing colectomy. Another concern in IBD is whether there is an increase in the number of other cancers, in particular lymphomas. One issue regarding lymphoma risk is whether immunomodulatory drug use predisposes to this cancer. One study of a large group of 6-mercaptopurine users did not suggest an increased risk for patients with IBD using this drug. There are a variety of nonintestinal problems that patients with IBD may confront. Osteopenia has received considerable attention in the past decade. This year, data have been published that quantify for the first time the risk of fractures in patients with IBD based on population, and these data were compared with a matched control group from the same population. Data on the further exploration of the issue of osteopenia in pediatric IBD have also been reported, as have some of the only studies of therapy for osteopenia in IBD. These and data on other extraintestinal manifestations of IBD have all emerged in the past year.

Ulcerative Colitis Practice Guidelines in Adults: American College of Gastroenterology, Practice Parameters Committee

“…IBD patients at greatest risk for fracture are over age 60 and all these subjects should be considered for dual-energy X-ray absorptiometry testing. Patients using corticosteroids beyond 3 months consecutively or who are recurrent users should likewise be considered for dualenergy X-ray absorptiometry testing and even prevention with bisphosphonate therapy ( 143,145,146 ). Prospective implementation of these guidelines in IBD patients identifi ed 44 % of IBD patients with osteopenia and 12 % with osteoporosis ( 147 ).…”

Inflammatory Bowel Disease Cause-specific Mortality

“… 6 , 7 Traditionally, clinicians have ascribed much of the excess morality in IBD to colorectal cancer (CRC); however, this may not be the primary driver of mortality, and practitioners managing IBD must be well versed in the landscape of threats that face patients today. 8 – 10 Addressing emerging threats such as venous thromboembolism (VTE) and Clostridium difficile infection (CDI), 8 , 9 , 11 – 19 navigating patient concerns over cardiovascular disease, 20 and addressing mortality concerns about new medical and surgical interventions are critical for the patient-centered practitioner. In an era of personalized medicine, this review assists clinicians in updating and summarizing the causes of mortality in IBD, to empower individual patients with information to participate in treatment decisions and inform them of early clinical warning signs that require immediate medical attention.…”

All Patients with Inflammatory Bowel Disease Should Have Bone Density Assessment

“…It would be cheap and easy to obtain routine chest X‐rays regularly on IBD patients, but this is not a routine practice either. So even though there is emerging evidence of increased risk of pulmonary conditions in IBD (11), most IBD clinicians would need to be convinced that routine testing of all patients is of value, even for something as simple as a chest X‐ray. This tenet holds for the use of DEXA in IBD as well.…”