No Increased Risk of Colorectal Neoplasia in Patients With Inflammatory Bowel Disease and Postinflammatory Polyps

Jong, Michiel E. de; Gillis, Veerle ELM; Derikx, Lauranne; Hoentjen, Frank

doi:10.1093/ibd/izz261

Cited by 16 publications

(24 citation statements)

References 18 publications

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“…For example, we observed that PIPs were not an independent risk factor for aCRN risk if outcomes were adjusted for the mean inflammation score. 44,45 HR and 95% CI from pooled analysis (pooled data if 2 studies were included in analysis). NSAIDs, nonsteroidal antiinflammatory drugs.…”

Section: Summary Of Identified Risk Factors For Advanced Colorectal Nmentioning

confidence: 99%

Prognostic Factors for Advanced Colorectal Neoplasia in Inflammatory Bowel Disease: Systematic Review and Meta-analysis

et al. 2021

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BACKGROUND AND AIMS: Patients with inflammatory bowel disease (IBD) have an increased risk of colorectal cancer (CRC). We performed a systematic review and meta-analysis to identify all prognostic factors for advanced colorectal neoplasia (aCRN, high-grade dysplasia or Q5 CRC) in patients with IBD. METHODS: A systematic literature search was conducted according to the MOOSE Q6 guidelines. Risk of bias was assessed using the Quality in Prognostic Studies tool. Random-effects models were created separately for odds and hazard ratios, different study designs, and univariable or multivariable data. The evidence for all prognostic factors was categorized as Q7 'weak,' 'moderate,' or 'strong,' based on estimate of effect sizes, heterogeneity, and risk of bias. RESULTS: A total of 164 studies were included allowing Q8 pooled analysis of 31 potential prognostic factors. In the univariable analysis, the evidence for extensive disease was classified as strong while evidence for low-grade dysplasia, strictures, primary sclerosing cholangitis, post Q9 -inflammatory polyps, family history of CRC, and ulcerative colitis versus Crohn's disease was considered moderate. Evidence for any dysplasia, colon segment resection, aneuploidy, male sex Q10 and age was classified as weak. In addition, histologic inflammation was identified as a risk factor in multivariable analysis (weak evidence). The evidence for the protective factors colonoscopic surveillance, 5-ASA Q11 , thiopurines, and smoking was moderate in univariable analysis. Multivariable analysis provided weak evidence for statin use. CONCLUSIONS: In this systematic review and meta-analysis Q12 we identified 13 risk factors and 5 protective factors for aCRN in IBD patients, based

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Section: Summary Of Identified Risk Factors For Advanced Colorectal Nmentioning

confidence: 99%

Prognostic Factors for Advanced Colorectal Neoplasia in Inflammatory Bowel Disease: Systematic Review and Meta-analysis

et al. 2021

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“…Strictures, lead pipe colon, and pseudopolyps, which are the cumulative result of inflammation, are considered structural risk factors. However, pseudopolyps probably do not represent per se a risk factor for colonic neoplasia, including CRC, as shown recently in a large, international, retrospective cohort study as well as prospective surveillance cohort with 22 years of follow-up [12,13]. In both studies, pseudopolyps were not independently associated with the risk of neoplasia after correction for colonic inflammation.…”

Section: Introductionmentioning

confidence: 64%

“…Risk factors for CRC in IBD colitis (adapted from[11]) CRC, colorectal cancer. * Newer studies indicate that pseudopolyps are not a risk factor[12,13].…”

mentioning

confidence: 99%

5-Aminosalicylic Acid Chemoprevention in Inflammatory Bowel Diseases: Is It Necessary in the Age of Biologics and Small Molecules?

Herfarth

Vavricka

2021

Inflamm Intest Dis

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Background: Due to the increased incidence of colorectal cancer in inflammatory bowel diseases (IBDs), the value of chemoprevention for this patient group has been repeatedly debated in the past decade. This review describes available evidence and the current recommendations for chemoprevention in national and international guidelines IBD guidelines. Summary: 5-Aminosalicylic acid (5-ASA) compounds are the preferred therapeutic option for mild to moderate ulcerative colitis (UC). Aside from the known anti-inflammatory effects, their chemopreventive abilities have been described in vitro and in vivo. Pooling the increasing number of retrospective and population-based clinical studies over the last 15 years, 7 consecutive meta-analyses revealed partially conflicting results for the chemopreventive efficacy of 5-ASA, and thus, not all IBD guidelines currently recommend chemoprevention with mesalamine compounds. Accumulating evidence for decreasing the colorectal cancer (CRC) risk in support of thiopurines more recently shows a protective effect. This effect seems solely mediated by control of intestinal inflammation since, for this drug class, another mechanistic interference in IBD-associated CRC pathogenesis is not known. The results regarding chemopreventive efficacy for ursodeoxycholic acid or folic acid are equivocal, and the use of these medications to prevent CRC is not firmly established. Like UC, the risk of CRC is also significantly increased in patients with Crohn’s disease (CD), especially Crohn’s colitis. However, no published studies exclusively assess the effects of surveillance on the early detection of cancer or CRC chemoprevention in CD patients. In meta-analyses, which predominantly included UC patients, 5-ASA or thiopurines were not beneficial in small CD subgroups. The level of evidence for anti-TNFα agents, anti-integrin (e.g., vedolizumab), or anti-IL-12/IL-23 agents (e.g., ustekinumab) and Janus kinase inhibitors is currently too low or nonexistent to use them solely for chemoprevention in UC or CD patients. Key Message: Intestinal inflammation is one of the main risk factors for developing CRC in IBD, and all drugs that induce and maintain mucosal healing most likely also decrease the IBD-associated CRC risk. Thus, a therapeutic strategy of adding a 5-ASA therapy to a successfully mucosal healing-inducing therapy, for example, with a biologic or a small molecule merely to prevent CRC appears to be obsolete.

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“…11,74 Subsequently, 2 large cohort studies specifically looking into neoplasia risk among IBD patients with IPs did not find a significant difference compared with patients without IPs. 75,76 Importantly, both studies found that IPs correlated with more severe inflammation, extensive disease, and higher rates of colectomy. Our data support these findings by showing that larger numbers and higher density of IPs are associated with more extensive anatomical involvement while having no increased risk of dysplasia, including advanced and occult neoplasia.…”

Section: Discussionmentioning

confidence: 99%

“…As proposed by recent studies, our results support the suggestion that IPs are not independently associated with increased risk of neoplasia in IBD patients, nor should they be considered reason for increased surveillance per se. 75,76 Interestingly, there have been reports of GIP regression after adequate medical therapy. 77,78 Nevertheless, an attempt to identify dysplasia (with adequate visualization and biopsy sampling, as per guidelines) in areas of IPs and surrounding mucosa should be documented.…”

Section: Discussionmentioning

confidence: 99%

Clinicopathologic Characteristics and Neoplasia Risk of Colorectal Inflammatory Polyposis in Inflammatory Bowel Disease

Yihong

Polydorides

2021

Archives of Pathology &Amp; Laboratory Medicine

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Context.— Inflammatory polyps (IPs) in inflammatory bowel disease may have been associated in the past with increased neoplasia risk. Additionally, colonic mucosa in filiform polyposis and giant inflammatory polyposis may be difficult to visualize during endoscopic surveillance, perhaps contributing to early colectomy in these patients. Objective.— To examine the clinicopathologic characteristics and significance of IPs and inflammatory polyposis in inflammatory bowel disease. Design.— We identified 336 resections from inflammatory bowel disease patients (212 [63.1%] male; mean age, 40.3 years; 175 [52.1%] with ulcerative colitis), including 78 with rare/few (<10) IPs, 141 with multiple (≥10) IPs, and 117 with inflammatory polyposis (including 30 with filiform polyposis/giant inflammatory polyposis) and compared them with 100 controls without IPs along various parameters, including overall and occult (unexpected) dysplasia. Results.— There was no increased neoplasia in resections with IPs compared with controls, given similar age, disease duration, degree of inflammation, anatomical extent of colitis, prevalence of primary sclerosing cholangitis, and tissue sampling. Increasing numbers of IPs and inflammatory polyposis were significantly associated in multivariate analysis with ulcerative and indeterminate colitis (P = .003) and shorter disease duration (P = .01), but also, and independently, with lower rates of dysplasia overall, including all grades (P = .001) and advanced neoplasia (P = .04). There were no instances of occult dysplasia (any grade) among inflammatory polyposis cases. Conclusions.— These findings support the conclusion that the presence of IPs per se, and inflammatory polyposis in particular (including filiform polyposis and giant inflammatory polyposis), should not be considered an independent risk factor for the development of neoplasia in inflammatory bowel disease patients, outside the context of disease duration and inflammatory burden.

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No Increased Risk of Colorectal Neoplasia in Patients With Inflammatory Bowel Disease and Postinflammatory Polyps

Cited by 16 publications

References 18 publications

Prognostic Factors for Advanced Colorectal Neoplasia in Inflammatory Bowel Disease: Systematic Review and Meta-analysis

Prognostic Factors for Advanced Colorectal Neoplasia in Inflammatory Bowel Disease: Systematic Review and Meta-analysis

5-Aminosalicylic Acid Chemoprevention in Inflammatory Bowel Diseases: Is It Necessary in the Age of Biologics and Small Molecules?

Clinicopathologic Characteristics and Neoplasia Risk of Colorectal Inflammatory Polyposis in Inflammatory Bowel Disease

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