Original article–alimentary tract
Colon Neoplasms Develop Early in the Course of Inflammatory Bowel Disease and Primary Sclerosing Cholangitis

https://doi.org/10.1016/j.cgh.2010.09.020Get rights and content

Background & Aims

Colon cancer surveillance guidelines for patients with inflammatory bowel disease (IBD) and primary sclerosing cholangitis (PSC) suggest annual colonoscopy once the diagnosis of concomitant disease is made, but there is little evidence to support this recommendation. We conducted a retrospective review of patients with colonic neoplasms (colon cancer or dysplasia) to test this guideline's validity and determined when colonic neoplasms occurred in the population.

Methods

Records were retrospectively reviewed from 54 patients with IBD, PSC, and colonic neoplasia for dates of diagnosis of IBD, PSC, and colon neoplasia and descriptive information about the colon neoplasms that developed.

Results

The occurrence of colon neoplasms within 2 years of diagnosis of IBD and PSC (21.5 per 100 patient years of follow-up) was similar to the occurrence within 8 to 10 years from diagnosis of IBD and PSC (20.4 per 100 patient years of follow-up). The colonic neoplasms that developed in this population were spread throughout the colon.

Conclusions

Patients with IBD and PSC have a risk of developing colonic neoplasms soon after the coexistence of the 2 diseases is discovered. This finding supports the current colon cancer surveillance guideline recommendations of yearly colonoscopies for this patient population, beginning at the time of diagnosis of PSC in patients with IBD or with the diagnosis of IBD in patients with PSC.

Section snippets

Patients and Methods

A computerized master diagnosis index was used to identify a population composed of IBD patients with coexisting PSC. Medical charts were then reviewed for pathology obtained from colonoscopy or surgery. Patients were included in the study if they were greater than 18 years old, had evidence of colon cancer or dysplasia on biopsy, and had their pathology reviewed by experienced gastroenterological Mayo Clinic pathologists. Patients did not need to have their colonoscopy done at Mayo to be

Patient Demographics and Clinical and Laboratory Features

The main clinical and laboratory data gathered during the first visit to our institution are summarized in Table 1. The 54 patients with IBD and PSC with colonic neoplasia included 16 female and 38 male patients. The average age at diagnosis of PSC was 43.4 ± 12.7 years (range, 35.7–50.7) and the average age at the time of the first visit to our institution for PSC was 46.9 ± 12.1 years (range, 40.3–54.1). Fifty patients (93%) had diffuse changes of the intra- and extrahepatic biliary system

Discussion

The findings of this study demonstrate that individuals with IBD and PSC may develop colon dysplasia or cancer relatively soon after the diagnosis of these 2 diseases. These findings are thus significant because they support the current surveillance guidelines for annual colonoscopies in patients with IBD and PSC and give a basis for counseling patients with these entities on their potential risk for colon neoplasia. Another important observation is the widespread nature of neoplasms, including

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Conflicts of interest The authors disclose no conflicts.

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