Original article—liver, pancreas, and biliary tract
Risk for Colorectal Neoplasia in Patients With Colonic Crohn's Disease and Concomitant Primary Sclerosing Cholangitis

https://doi.org/10.1016/j.cgh.2011.10.020Get rights and content

Background & Aims

Patients with ulcerative colitis and concomitant primary sclerosing cholangitis (PSC) have a greater risk of developing colorectal dysplasia or invasive cancer than patients with only ulcerative colitis. Therefore, annual surveillance colonoscopies are recommended. We investigated whether primary sclerosing cholangitis is also a risk factor for colorectal dysplasia or cancer in patients with Crohn's disease of the colon.

Methods

We performed a retrospective review of data from a tertiary care hospital on 166 patients with PSC and inflammatory bowel disease; 120 had concomitant ulcerative colitis, 35 had Crohn's disease, and 11 had indeterminate colitis. The controls comprised 114 patients with colonic involvement of Crohn's disease and 102 patients with ulcerative colitis. The main outcome parameter was the development of colorectal cancer or intraepithelial neoplasia.

Results

Only 1 patient with colonic Crohn's disease and concomitant PSC developed dysplasia in an adenomatous polyp during a median follow-up of 10 years (range, 7–16 years). In contrast, 2 cancers and 8 cases of colorectal dysplasia were diagnosed in patients with ulcerative colitis and PSC during a median follow up of 11 years (range, 8–16 years); the crude annual incidence of dysplasia or colorectal cancer was 1 in 150 patients with ulcerative colitis. Among patients with colonic Crohn's disease without PSC, 2 developed colorectal cancer during follow-up. The presence of PSC did not increase the risk of developing colorectal dysplasia in patients with Crohn's disease (P = 1.00).

Conclusions

PSC does not seem to increase the risk for dysplasia of the colon in patients with colonic Crohn's disease.

Section snippets

Patients

We studied 166 patients with PSC and colonic inflammatory bowel disease from our database of PSC patients treated in the John Radcliffe Hospital in Oxford. Only PSC patients with established diagnosis of Crohn's disease, ulcerative colitis, or indeterminate colitis were included. Patients with PSC without inflammatory bowel disease or inflammatory bowel disease of less than 5 years were not included in this study. Patients with duration of PSC of less than 3 years were also excluded.

The

Results

Demographic characteristics of the patient groups with inflammatory bowel disease with and without PSC are given in Table 1. The majority of patients with PSC and inflammatory bowel disease were being treated with ursodeoxycholic acid at a daily dose of 15 to 20 mg/kg body weight; 74% of the patients with PSC and Crohn's disease, 82% of patients with PSC and indeterminate colitis, and 79% of the patients with PSC and ulcerative colitis received ursodeoxycholic acid (Table 2). Apart from 1

Discussion

Despite evidence showing that PSC is a risk factor for colorectal cancer in patients with ulcerative colitis4 and that there is increased risk of colorectal cancer in patients with Crohn's disease similar to longstanding ulcerative colitis,12 it is unclear whether PSC is an additional risk factor for colorectal cancer in patients with Crohn's colitis. We have investigated this in the current study by comparing the prevalence of colorectal neoplasia in 5 groups of patients; patients with Crohn's

References (35)

Cited by (45)

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    2022, Gastroenterology Clinics of North America
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    Citation Excerpt :

    A study conducted in England included 166 patients with IBD/PSC – 120 patients with UC/PSC, 35 patients with CD/PSC, and 11 patients with indeterminate colitis/PSC. The occurrence of nondysplastic adenomas and colorectal cancer was more frequent in patients with UC/PSC than in patients with CD/PSC (p = 0.07).36 Another study conducted in Sweden compared 28 patients with CD/PSC with 46 patients with CD alone.

  • Effects of Primary Sclerosing Cholangitis on Risks of Cancer and Death in People With Inflammatory Bowel Disease, Based on Sex, Race, and Age

    2020, Gastroenterology
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    This is likely because of our enrollment criteria, which excluded patients diagnosed at <18 years of age and, hence, those with pediatric age–onset PSC. Regardless, data from several independent sources confirm an older age at PSC diagnosis in the United Kingdom compared to other European and North American centers.20,35,48,49 Importantly, we find that patients diagnosed at non–transplant centers are older at PSC diagnosis compared to those from liver transplant units.

  • Colorectal Cancer in Patients With Inflammatory Bowel Disease: The Need for a Real Surveillance Program

    2016, Clinical Colorectal Cancer
    Citation Excerpt :

    Among patients with colonic CD without PSC, 2 developed CRC during follow-up. The presence of PSC did not increase the risk of developing colorectal dysplasia in patients with CD (P = 1.00).48 Also, Loftus et al reported in their study that among IBD subtypes, PSC was more common in UC than CD (80% vs. 10% of cases).49

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This article has an accompanying continuing medical education activity on page e31. Learning Objective—At the end of this activity, the learner will identify the risk for the development of colorectal neoplasia in patients with colonic Crohn's disease and concomitant primary sclerosing cholangitis compared to patients with ulcerative colitis and concomitant primary sclerosing cholangitis.

Conflicts of interest The authors disclose no conflicts.

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