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.

Download full-text


Available from: Tine Jess, Mar 13, 2015
  • Source
    • "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. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Colorectal cancer is one of the most common malignancies and the most dreadful long-term complication in patients with ulcerative colitis. The incidence rate of colorectal cancer ranks second among the malignancies all over the world, and the number is still rising. Amid the many risk factors for colorectal cancer, ulcerative colitis is becoming increasingly prominent. The risk of colorectal cancer in ulcerative colitis patients is estimated to be as high as 40%. There is now a consensus that patients with long-lasting ulcerative colitis (>10 years) carries an increased risk of dysplasia and cancer. Taking into account evidence from the current studies, the longer ulcerative colitis lasts, the higher risk of colitis-associated colorectal cancer occurs. Unlike sporadic colorectal cancer, colitis-associated colorectal cancer usually derives from focal or multifocal dysplastic mucosa in areas of inflammation through an inflammation-dysplasia-carcinoma sequence. The prognosis of colorectal cancer is poorer in patients with ulcerative colitis than those without. Therefore the presence of dysplasia in ulcerative colitis patients is a critical indication of cancer that we should watch out for. Thus, early detection and resection of precursor lesions, mainly dysplasia, to terminate the cancerous progression is of great importance. To date, chemoprophylaxis, colonoscopy surveillance and proctocolectomy have been encouraged to prevent and manage dysplastic lesions in ulcerative colitis. This article attempts to give an overview of current research of dysplasia and prevention/management of dysplasia and colitis-associated colorectal cancer in ulcerative colitis.
    Preview · Article · Jan 2011 · Asian Pacific journal of cancer prevention: APJCP
  • Source

    Preview · Article · Sep 2006 · Gastroenterology

  • No preview · Article · Sep 2006 · Gastroenterology
Show more