IBD Watch^®

^{Timely Information for Practicing Physicians}

NOVEMBER 2007

Histologic inflammation is a risk factor for progression to neoplasia. Gupta and others studied a cohort of 418 patients with ulcerative colitis (UC) who were undergoing regular endoscopic surveillance for dysplasia. Inflammation at each biopsy site was summarized by mean inflammatory score, binary inflammatory score, and maximum inflammatory score. Among the 418 patients, 65 progressed to neoplasia, with 15 developing high-grade dysplasia or colorectal cancer. Multivariable analysis demonstrated a significant relationship between histologic inflammation over time and progression to advanced neoplasia. This study showed that the severity of microscopic inflammation over time is an independent risk factor for developing colorectal neoplasia in patients with UC. (Gupta RB, et al. Gastroenterology. 2007;133:1099–1105.)

Patient perceptions of infliximab. Siegel and co-workers analyzed the perceptions of adult patients with IBD and the parents of patients with IBD toward the risks and benefits of infliximab therapy. Questionnaires were distributed at IBD educational symposia; 165 were completed. Among respondents, 59% expected remission rates to be >50% at 1 year while 18% expected remission rates to be >70% at 1 year. Furthermore, 37% of respondents believed that infliximab was not associated with a risk of lymphoma and 67% believed that the lymphoma risk associated with the use of infliximab was no higher than twice that of the general population. However, when presented with a hypothetical scenario of a new drug for IBD with risks identical to those of infliximab, 64% of respondents indicated they would not take the treatment despite its benefits. Thirty percent of these patients were either taking infliximab or had previously received infliximab. Patients currently receiving infliximab predicted the highest remission rates for their treatment, and parents of patients predicted the lowest remission rates. In addition, parents estimated a higher risk of lymphoma than did patients. These results demonstrate that communication to patients of the risks and benefits of infliximab therapy needs to improve. ( Siegel CA , et al. Inflamm Bowel Dis. 2007 Oct 9; [Epub ahead of print].)

Pregnancy outcomes. Mahadevan and associates studied pregnant women within the Northern California Kaiser Permanente membership between 1995 and 2002 to determine whether pregnancy outcomes differed between women with and without IBD. A total of 461 pregnant women with IBD were matched to 493 pregnant women without IBD. Adverse newborn outcomes were not statistically significantly different between the two groups. However, women with IBD were more likely to have an adverse conception outcome (odds ratio [OR], 1.65; 95% confidence interval [CI], 1.09 to 2.48), adverse pregnancy outcome (OR, 1.54; 95% CI, 1.00 to 2.38), or complication of pregnancy (OR, 1.78; 95% CI, 1.13 to 2.81). Independent predictors of an adverse outcome were a diagnosis of IBD, a history of surgery for IBD, and non-Caucasian ethnicity. Neither severity of IBD nor medical treatments was associated with an adverse outcome. Thus, while women with IBD were more likely to have an adverse pregnancy outcome, disease activity and medical treatment were not predictive of adverse outcomes in this study. (Mahadevan U, et al. Gastroenterology 2007;133:1106–1112.)

Exposure to diagnostic medical radiation. Newnham and colleagues analyzed incidences of exposure to diagnostic medical radiation in a consecutive series of 100 patients with IBD (62 patients with Crohn’s disease [CD], 37 patients with UC, and 1 patient with indeterminate colitis). Thirteen patients did not receive diagnostic medical radiation. An effective dose of diagnostic medical radiation of >25 mSv was received by 23 patients and an at-risk effective dose of >50 mSv was received by 11 patients. Patients with CD received higher doses of diagnostic medical radiation than did patients with UC. These results showed that at-risk radiation from diagnostic medical procedures is common in patients with IBD and may contribute to the elevated risk of intra-abdominal cancers that is seen in this population. (Newnham E, et al. Aliment Pharmacol Ther. 2007;26:1019–1024.)

Risk for lymphoma. Jones and Loftus discuss the risk of lymphoma in patients with IBD. The use of biologic and immunosuppressive agents for the management of CD and UC has raised concerns about the potential long-term risk for treatment-related lymphoma. The risk of lymphoma due to underlying IBD has been difficult to discern and confounds the determination of the risk for therapy-related lymphoma in patients with IBD. Population-based evidence suggests that a diagnosis of IBD is not associated with an increased risk of lymphoma, but no well-designed studies evaluating the potential effect of IBD severity have been performed. Recent meta-analyses indicate that patients with IBD who receive purine analogs have a lymphoma risk approximately four-fold higher than expected. There may also be a small but real risk of lymphoma associated with the use of biologic agents directed against tumor necrosis factor–alpha, although these analyses are confounded by the use of concomitant immunosuppressive agents. The authors concluded that weighing the potential risk of lymphoma associated with a medical therapy against the risk of under-treating IBD will help physicians and patients make informed decisions concerning IBD management. (Jones JL, Loftus EV Jr. Inflamm Bowel Dis. 2007;13:1299–1307.)

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