Inflammation in the proximal colon is a risk factor for the development of colorectal neoplasia in inflammatory bowel disease patients with primary sclerosing cholangitis

Omar K Jamil; Dustin Shaw; Zifeng Deng; Nicholas Dinardi; Natalie Fillman; Shivani Khanna; Noa Krugliak Cleveland; Atsushi Sakuraba; Christopher R Weber; Russell D Cohen; Sushila Dalal; Bana Jabri; David T Rubin; Joel Pekow

doi:10.1177/17562848231184985

Inflammation in the proximal colon is a risk factor for the development of colorectal neoplasia in inflammatory bowel disease patients with primary sclerosing cholangitis

Therap Adv Gastroenterol. 2023 Sep 7:16:17562848231184985. doi: 10.1177/17562848231184985. eCollection 2023.

Affiliations

¹ Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, IL, USA.
² Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, IL, USA Digestive Diseases Research Core Center, University of Chicago Medicine, Chicago, IL, USA.
³ Department of Allergy and Immunology, Johns Hopkins University, Baltimore, MD, USA.
⁴ Department of Pathology, University of Chicago Medicine, Chicago, IL, USA.
⁵ Inflammatory Bowel Disease Center, University of Chicago Medicine, 900 East 57th Street, MB #9, Chicago, IL 60637, USA.

Abstract

Background: Patients with primary sclerosing cholangitis (PSC) and inflammatory bowel disease (IBD) have an increased risk of developing colorectal neoplasia (CRN) in the proximal colon.

Objectives: To evaluate whether duration and severity of inflammation are linked to the development of CRN in this population.

Design: Retrospective, case-control chart review of patients with PSC and IBD at a tertiary care center.

Methods: Disease activity was scored per colonic segment at each colonoscopy prior to the first instance of observed CRN using a modified Mayo endoscopic sub-score and histologic assessment. Patients in the CRN-positive group were compared to controls that did not.

Results: In all, 72 PSC-IBD patients with no history of CRN were identified, 13 of whom developed CRN after at least one colonoscopy at our institution. Patients in the CRN-positive group had significantly more endoscopic (p < 0.01) and histologic (p < 0.01) inflammation in the right compared to the control group prior to the development of dysplasia. There was significantly greater endoscopic inflammation in the segment of the colon with a dysplastic lesion than other segments of the colon (p = 0.018). Patients with moderate/severe lifetime endoscopic (p = 0.02) or histologic inflammation (p = 0.04) score had a lower probability of remaining free of dysplasia during follow-up. Nearly half of the patients with dysplasia had invisible lesions found on random biopsy.

Conclusions: Endoscopic and histologic inflammation in the proximal colon are risk factors for CRN in patients with PSC-IBD. PSC-IBD patients frequently have subclinical inflammation, and these findings support the practice of regular assessment of disease activity and random biopsy of inflamed and uninflamed areas in patients with PSC with the goal of reducing inflammation to prevent the development of CRN.

Keywords: IBD variants; dysplasia; right colon.

Plain language summary

Patients with PSC and IBD have not been examined as a cohort to assess for risk factors for CRN. We found that severe inflammation in the proximal colon is the main risk factor for CRN in these patients.

Inflammation in the proximal colon is a risk factor for the development of colorectal neoplasia in inflammatory bowel disease patients with primary sclerosing cholangitis

Authors

Affiliations

Abstract

Plain language summary

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