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).
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.
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.
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.
"High-risk types of HPV (eg, types 16 and 18) are associated with 70% of all cervical and anogenital cancers . In women with IBD several studies have shown that their risk for cervical pap smear abnormalities and HPV infection is three to five times higher than well match controls   . Nevertheless other studies have not found an association between IBD and cervical dysplasia unless patients are under immunosuppressive therapy or they smoke  . "
[Show abstract][Hide abstract] ABSTRACT: This paper describes features of EXEL, a graphic language that gives the designer control over the behavioral synthesis process. Control is achieved by allowing the designer to partially specify the structural design into which the description is going to be compiled, or by binding desired variables and operators to particular components or connections, and binding desired operations to particular states of the final design. EXEL's compiler runs on SUN-3 workstations and is written in C and SUNVIEW.
[Show abstract][Hide abstract] ABSTRACT: Crohn's disease and ulcerative colitis are chronic inflammatory conditions involving the gastrointestinal tract. Although many aspects of the management of these diseases are identical for all patients, some issues that are specific to women are not necessarily part of routine care. Gender-specific issues such as menses, fertility, pregnancy, and menopause are often overlooked and mismanaged. Women and men also have different psychological concerns arising from the disease. Health care providers, regardless of their primary focus, should be aware of these differences and should be familiar with certain general information on gender-specific issues, reviewed in this article.
The journal of gender-specific medicine: JGSM: the official journal of the Partnership for Women's Health at Columbia 02/2001; 4(1):54-9.
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