Jamil Omar K, Shaw Dustin, Deng Zifeng, Dinardi Nicholas, Fillman Natalie, Khanna Shivani, Krugliak Cleveland Noa, Sakuraba Atsushi, Weber Christopher R, Cohen Russell D, Dalal Sushila, Jabri Bana, Rubin David T, Pekow Joel
Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, IL, USA.
Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, IL, USA Digestive Diseases Research Core Center, University of Chicago Medicine, Chicago, IL, USA.
Therap Adv Gastroenterol. 2023 Sep 7;16:17562848231184985. doi: 10.1177/17562848231184985. eCollection 2023.
Patients with primary sclerosing cholangitis (PSC) and inflammatory bowel disease (IBD) have an increased risk of developing colorectal neoplasia (CRN) in the proximal colon.
To evaluate whether duration and severity of inflammation are linked to the development of CRN in this population.
Retrospective, case-control chart review of patients with PSC and IBD at a tertiary care center.
Disease activity was scored per colonic segment at each colonoscopy prior to the first instance of observed CRN using a modified Mayo endoscopic sub-score and histologic assessment. Patients in the CRN-positive group were compared to controls that did not.
In all, 72 PSC-IBD patients with no history of CRN were identified, 13 of whom developed CRN after at least one colonoscopy at our institution. Patients in the CRN-positive group had significantly more endoscopic ( < 0.01) and histologic ( < 0.01) inflammation in the right compared to the control group prior to the development of dysplasia. There was significantly greater endoscopic inflammation in the segment of the colon with a dysplastic lesion than other segments of the colon ( = 0.018). Patients with moderate/severe lifetime endoscopic ( = 0.02) or histologic inflammation ( = 0.04) score had a lower probability of remaining free of dysplasia during follow-up. Nearly half of the patients with dysplasia had invisible lesions found on random biopsy.
Endoscopic and histologic inflammation in the proximal colon are risk factors for CRN in patients with PSC-IBD. PSC-IBD patients frequently have subclinical inflammation, and these findings support the practice of regular assessment of disease activity and random biopsy of inflamed and uninflamed areas in patients with PSC with the goal of reducing inflammation to prevent the development of CRN.
原发性硬化性胆管炎（PSC）和炎症性肠病（IBD）患者近端结肠发生结直肠肿瘤（CRN）的风险增加。
评估炎症的持续时间和严重程度是否与该人群中CRN的发生有关。
对一家三级医疗中心的PSC和IBD患者进行回顾性病例对照图表审查。
在首次观察到CRN之前的每次结肠镜检查时，使用改良的梅奥内镜亚评分和组织学评估对每个结肠段的疾病活动进行评分。将CRN阳性组的患者与未发生CRN的对照组进行比较。
总共确定了72例无CRN病史的PSC-IBD患者，其中13例在我们机构至少接受一次结肠镜检查后发生了CRN。在发育异常发生之前，CRN阳性组患者右侧的内镜（<0.01）和组织学（<0.01）炎症明显多于对照组。有发育异常病变的结肠段的内镜炎症明显大于结肠的其他段（=0.018）。终身内镜（=0.02）或组织学炎症评分中等/严重的患者在随访期间无发育异常的概率较低。近一半的发育异常患者在随机活检中发现了不可见病变。
近端结肠的内镜和组织学炎症是PSC-IBD患者发生CRN的危险因素。PSC-IBD患者经常有亚临床炎症，这些发现支持定期评估疾病活动并对PSC患者的炎症和非炎症区域进行随机活检的做法，目的是减轻炎症以预防CRN的发生。
