Higher Incidence of Abnormal Pap Smears in Women With Inflammatory Bowel Disease

Mayo Clinic, Rochester, Minnesota 55905, USA.
The American Journal of Gastroenterology (Impact Factor: 10.76). 04/2008; 103(3):631-6. DOI: 10.1111/j.1572-0241.2007.01582.x
Source: PubMed


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.

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    • "High-risk types of HPV (eg, types 16 and 18) are associated with 70% of all cervical and anogenital cancers [50]. 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 [51] [52] [53]. Nevertheless other studies have not found an association between IBD and cervical dysplasia unless patients are under immunosuppressive therapy or they smoke [54] [55]. "
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