Risk for Colorectal Neoplasia in Patients With Colonic Crohns Disease and Concomitant Primary Sclerosing Cholangitis

Clinical Gastroenterology and Hepatology ,

Primary sclerosing cholangitis (PSC) does not seem to increase the risk for dysplasia of the colon in patients with colonic Crohn's disease.

Methods

  • The authors performed a retrospective review of data from a tertiary care hospital on 166 patients with PSC and inflammatory bowel disease; 120 had concomitant ulcerative colitis, 35 had Crohn's disease, and 11 had indeterminate colitis.
  • The controls comprised 114 patients with colonic involvement of Crohn's disease and 102 patients with ulcerative colitis.
  • The main outcome parameter was the development of colorectal cancer or intraepithelial neoplasia.

Results

  • Only 1 patient with colonic Crohn's disease and concomitant PSC developed dysplasia in an adenomatous polyp during a median follow-up of 10 years (range, 7–16 years).
  • In contrast, 2 cancers and 8 cases of colorectal dysplasia were diagnosed in patients with ulcerative colitis and PSC during a median follow up of 11 years (range, 8–16 years); the crude annual incidence of dysplasia or colorectal cancer was 1 in 150 patients with ulcerative colitis.
  • Among patients with colonic Crohn's disease without PSC, 2 developed colorectal cancer during follow-up.
  • The presence of PSC did not increase the risk of developing colorectal dysplasia in patients with Crohn's disease (P = 1.00).

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