Incidence and Prognosis of Colorectal Dysplasia in Inflammatory Bowel Disease: A Population-based Study from Olmsted County, Minnesota

Department of Medical Gastroenterology, Herlev University Hospital, Herlev, Denmark.
Inflammatory Bowel Diseases (Impact Factor: 4.46). 09/2006; 12(8):669-76. DOI: 10.1097/00054725-200608000-00001
Source: PubMed


The risk, fate, and ideal management of colorectal dysplasia in inflammatory bowel disease (IBD) remain debated. We estimated the incidence, long-term outcome, and risk factors for progression of colorectal dysplasia (adenomas [adenoma-associated lesions or masses (ALMs)], flat dysplasia, and dysplasia-associated lesions or masses [DALMs]) in a population-based IBD cohort from Olmsted County, Minnesota.
The Rochester Epidemiology Project was used to identify cohort patients with colorectal dysplasia. Medical records were reviewed for demographic and clinical characteristics. Histology slides were reviewed by a pathologist blinded to previous pathology reports. The cumulative incidence of dysplasia was estimated, and the association between patient characteristics and recurrence/progression of dysplasia was assessed using proportional hazards regression.
Twenty-nine (4%) IBD patients developed flat dysplasia (n = 8), DALMs (n = 1), ALMs in areas of IBD (n = 18), or ALMs outside areas of IBD (n = 2). Among 6 patients with flat low-grade dysplasia (fLGD) who did not undergo colectomy, none progressed during a median of 17.8 (range 6-21) years of observation with a median of 3 (range 0-12) surveillance colonoscopies. Four (22%) patients with ALMs in areas of IBD who did not undergo surgery developed LGD or DALMs. Primary sclerosing cholangitis and dysplasia located proximal to the splenic flexure were significantly associated with risk for recurrence/progression of dysplasia.
This population-based cohort study from Olmsted County, Minnesota did not confirm an increased risk of cancer related to fLGD, whereas 22% of patients with ALMs in areas of IBD developed fLGD or DALMs.

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Available from: Tine Jess, Mar 13, 2015
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    • "In the case of low grade dysplasia, however, the situation remains controversial. Some research demonstrate that low grade dysplasia is not sufficiently reliable to justify prophylactic colectomy (Lim et al., 2003; Jess et al., 2006), while others show that early colectomy should be recommended in UC patients with low grade dysplasia ( Bernstein et al., 1994; Ullman et al., 2002; 2003). In view of the current research, we are in favor of early surgery for all the patients with dysplasia of any grade under the condition that the patients yield their consent after informed the gains and losses of colectomy. "
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