Higher incidence of abnormal Pap smears in women with inflammatory bowel disease

Am J Gastroenterol. 2008 Mar;103(3):631-6. doi: 10.1111/j.1572-0241.2007.01582.x. Epub 2007 Oct 17.

Abstract

Background and aims: Immunosuppression results in a higher incidence of cervical dysplasia compared with healthy controls. We examined the relationship between immunomodulator use and the presence of abnormal cervical histology in women with inflammatory bowel disease (IBD).

Methods: Women with IBD and serial Pap smears were recruited. Patients were compared to age-, race-, and parity-matched controls. Pap smears were recorded in relation to exposure to immunomodulators. Variables included diagnosis, type and duration of immunosuppressant, and smoking.

Results: Forty patients (8 UC, 32 CD) with 134 Pap smears were included. The incidence of any abnormal Pap in a woman with IBD was 42.5%versus 7% of controls (P < 0.001). Women with IBD were more likely to have higher-grade lesions than controls (P < 0.001). Those women with a history of exposure to immunosuppression were more likely to have an abnormal Pap smear (P < 0.001) than controls. Pap smears done with > 6 months exposure to an immunosuppressant resulted in increased risk (OR 1.5, 1.2-4.1, P= 0.021). Cytopathology of abnormal lesions revealed either HPV serotype 16 or 18 in all specimens. Multivariate analysis did not reveal any differences between the groups when controlled for other variables.

Conclusions: Women with IBD have a higher risk of an abnormal Pap smear compared with healthy controls. Patients with immunomodulator use have a higher risk of an abnormal Pap smear associated with HPV infection. Women with IBD should be included in the American College of Obstetrics and Gynecology screening guidelines for immunocompromised individuals.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cervical Intraepithelial Neoplasia / diagnosis
  • Cervical Intraepithelial Neoplasia / etiology
  • Colitis, Ulcerative / complications*
  • Colitis, Ulcerative / drug therapy
  • Crohn Disease / complications*
  • Crohn Disease / drug therapy
  • Female
  • Humans
  • Immunocompromised Host
  • Immunosuppressive Agents / therapeutic use
  • Papanicolaou Test*
  • Papillomavirus Infections / immunology
  • Risk Factors
  • Uterine Cervical Dysplasia / diagnosis
  • Uterine Cervical Dysplasia / etiology*
  • Uterine Cervical Neoplasms / diagnosis
  • Uterine Cervical Neoplasms / etiology
  • Vaginal Smears*

Substances

  • Immunosuppressive Agents