Gastrointestinal neoplasia in patients with inflammatory bowel disease: Opportunities to enhance preventative strategies

Edward Young; Matthew Lawrence; Michelle Thomas; Jane Andrews

doi:10.1002/jgh3.12193

Gastrointestinal neoplasia in patients with inflammatory bowel disease: Opportunities to enhance preventative strategies

JGH Open. 2019 May 14;3(6):513-517. doi: 10.1002/jgh3.12193. eCollection 2019 Dec.

Authors

Edward Young¹, Matthew Lawrence², Michelle Thomas², Jane Andrews^{1

3}

Affiliations

¹ Royal Adelaide Hospital, Department of Gastroenterology and Hepatology, IBD Service Royal Adelaide Hospital Adelaide South Australia Australia.
² Colorectal Surgery Unit Royal Adelaide Hospital Adelaide South Australia Australia.
³ University of Adelaide Adelaide South Australia Australia.

Abstract

Background and aims: Gastrointestinal (GI) adenocarcinoma, especially colorectal cancer (CRC), is a devastating complication of inflammatory bowel disease (IBD). We sought to examine the role of chronic inflammation and other possible predictors of the development of CRC, as well as assess as yet unexamined factors such as psychological comorbidity and engagement in care.

Methods: This study included all patients involved in a tertiary hospital IBD service diagnosed with CRC between 2007 and 2017. Reports from histological specimens were assessed, and all those with adenocarcinoma, high-grade dysplasia (HGD), or multifocal low-grade dysplasia (LGD) originating within IBD-affected mucosa were included in the study.

Results: A total of 32 patients were included in the study (17 with adenocarcinoma and 15 with HGD/multifocal LGD). The majority had a duration of disease >20 years. Eleven patients (34%, CI 20-52%) had previous disease-related surgery, and 16 (50%, CI 34-66%) had multiple previous disease-related admissions. Thirteen patients (62%, CI 41-79%) had >50% of CRP results higher than 8 mg/L. Psychiatric comorbidities were common, with 19 patients (59%, CI 42-74%) having a psychiatric comorbidity or poor engagement in treatment.

Conclusion: In this cohort, we have highlighted poor engagement, hesitation to up-titrate therapy when indicated, and psychological comorbidities as likely contributors to poor disease control and development of GI adenocarcinoma. Based on our data, these easily identifiable clinical care factors should not be overlooked when addressing IBD-related GI malignancy prevention. Additional research is required to assess a direct causal relationship, but this study would support the incorporation of psychology services into IBD clinics.

Keywords: IBD: clinical trials; colorectal cancer: clinical research; colorectal cancer: epidemiology and surveillance; neoplasia; prevention and chemoprevention.