IBD Watch^®

^{Timely Information for Practicing Physicians}

 AUGUST 2006

Factors associated with colorectal cancer. Velayos and others determined the variables associated with colorectal cancer in 188 patients with colorectal cancer related to ulcerative colitis (UC), and matched controls. Conditional logistic regression, adjusted for age and duration of colitis, identified that a history of postinflammatory pseudopolyps was associated with an increased risk of colorectal cancer (odds ratio [OR], 2.5; 95% confidence interval [CI], 1.4 to 4.6). Factors associated with a reduced risk of colorectal cancer included one or two surveillance colonoscopies and the use of corticosteroids, aspirin, nonsteroidal anti-inflammatory drugs, and 5-aminosalicylic acid. (Velayos FS, et al. Gastroenterology 2006;130:1941–1949.) (Editor’s Note: These results add a history of pseudopolyps—possibly an indicator of severe inflammation—to the list of recognized factors that correlate with an increased risk of colorectal cancer in patients with UC and support the role of anti-inflammatory agents, including 5-aminosalicylic acid, and surveillance colonoscopies, to decrease the risk—S.H.)

Immunosuppression: A role in the management and development of inflammatory bowel disease (IBD). Moskovitz et al retrospectively studied 142 patients with UC who were treated with cyclosporine between 1992 and 2004. A total of 118 patients (83%) responded to cyclosporine therapy and did not require colectomy during initial hospitalization. However, 64 (54%) of these 118 patients required colectomy at a later date. Patients who were already receiving azathioprine had a higher rate of colectomy than did patients who started azathioprine with the initiation of cyclosporine (59% vs 31%; P <0.05). In addition, life-table analysis showed that 88% of patients will require colectomy within 7 years of starting cyclosporine. Thus, while cyclosporine is an effective short- to medium-term treatment for severe UC, most patients receiving this drug will eventually require a colectomy (Editor’s Note: Unless azathioprine is initiated after induction therapy with cyclosporine.—S.H.). In a second report, Worns and associates described five patients who developed de novo IBD following orthotopic liver transplantation (OLT) and allograft immunosuppressive therapy. The patients had histologic findings typical of UC and all patients were suspected to have an autoimmune background. Treatment with aminosalicylates and corticosteroids induced clinical and histologic remission, but relapses occurred frequently. These cases indicated that an immune dysregulation may lead to the development of de novo IBD in patients undergoing OLT and immunosuppressive treatment. (Moskovitz DN, et al. Clin Gastroenterol Hepatol 2006; epub May 22; Worns MA, et al. Am J Gastroenterol 2006; epub June 22).

Survival of patients with UC-related colorectal cancer. Jensen and coworkers conducted a nationwide population-based study in Denmark to examine the prognosis of patients with UC-related colorectal cancer. From the Danish Cancer and Hospital Discharge Registries they identified all patients diagnosed with these diseases between 1977 and 1999. Clinical data from 279 patients with UC-related colorectal cancer were compared with data from 71,259 patients with colorectal cancer without UC. The mean age at the time of the diagnosis of colorectal cancer was 62.6 years in the patients with UC and 71.2 years in the patients without UC. Colorectal cancer stage at diagnosis was similar in both patient groups. However, the mortality ratio of patients with UC compared with patients without UC was 1.24 (95% CI, 1.02 to 1.51) in the first year and 1.17 (95% CI, 1.01 to 1.36) after 5 years of follow-up. These data suggest that the prognosis of colorectal cancer for patients with UC is poorer than that for patients without UC. (Jensen AB, et al. Am J Gastroenterol 2006;101:1283–1287.)

Factors associated with a decrease in the extent of disease. Picco and others evaluated disease extent (pancolitis, left-sided colitis, and proctosigmoiditis) in 102 patients with long-standing UC who had undergone two consecutive colonoscopies with surveillance biopsies. They found agreement between gross and microscopic findings to be poor (kappa = 0.39). The achievement of clinical remission and the use of oral mesalamine were identified to be independently associated with a decrease in disease extent. Therapy with folic acid, topical mesalamine, corticosteroids, and immunomodulators were not found to reduce the extent of UC involvement significantly. These findings indicate that among patients with long-standing UC, disease remission and oral mesalamine treatment were independently associated with decreases in disease extent. (Picco MF, et al. Inflamm Bowel Dis 2006;12:537–542.)

Detection of postsurgical Crohn’s disease (CD) recurrence. Bourreille and colleagues compared the ability of ileocolonoscopy and wireless capsule endoscopy (WCE) to detect the recurrence of CD following ileocolonic resection in 32 patients. Recurrence occurred in 21 patients (68%) and was detected by ileocolonoscopy in 19 patients (sensitivity, 90%; specificity, 100%). Depending on assumptions, the sensitivity of WCE was 62% and 76% and the specificity was 100% and 90%. Lesions located outside of the scope of endoscopy were detected by WCE in two thirds of patients with a higher rate of interobserver agreement. These results show that the ability of WCE to detect CD recurrence after surgery is inferior to that of ileocolonoscopy. However, WCE complements endoscopy as this procedure detected lesions outside the scope of ileocolonoscopy. (Bourreille A, et al. Gut 2006;55:978–983.)

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