Risk factors for colorectal neoplasia in inflammatory bowel disease: a nested case-control study from Copenhagen county, Denmark and Olmsted county, Minnesota

TY - JOUR

T1 - Risk factors for colorectal neoplasia in inflammatory bowel disease

T2 - a nested case-control study from Copenhagen county, Denmark and Olmsted county, Minnesota

AU - Jess, Tine

AU - Loftus, Edward V

AU - Velayos, Fernando S

AU - Winther, Karen V

AU - Tremaine, William J

AU - Zinsmeister, Alan R

AU - Scott Harmsen, W

AU - Langholz, Ebbe

AU - Binder, Vibeke

AU - Munkholm, Pia

AU - Sandborn, William J

PY - 2007/4

Y1 - 2007/4

N2 - OBJECTIVES: Population-based data on risk factors and protective factors for colorectal dysplasia and cancer in patients with inflammatory bowel disease (IBD) are sparse. We conducted a nested case-control study of such factors in two well-described IBD cohorts from Copenhagen County, Denmark and Olmsted County, Minnesota.METHODS: Forty-three neoplasia cases were matched on six criteria to 1-3 controls (N = 102). Medical records were scrutinized for demographic and clinical data. For each variable, the odds of neoplasia were estimated using conditional logistic regression.RESULTS: Primary sclerosing cholangitis (PSC) (odds ratio [OR] 6.9, 95% confidence interval [CI] 1.2-40), percentage of disease course with clinically active disease (OR [per 5% increase] 1.2, 95% CI 0.996-1.4), and >or=1 yr of continuous symptoms (OR 3.2, 95% CI 1.2-8.6) were associated with neoplasia, whereas a borderline association with median number of small-bowel x-rays (OR 1.3, 95% CI 0.96-1.6) was observed. We did not observe a protective effect of frequency of physician visits (OR 1.4, 95% CI 0.96-2.0), number of colonoscopies (OR 1.4, 95% CI 1.0-2.1), cumulative dose of sulfasalazine (OR [per 1,000 g] 1.1, 95% CI 1.0-1.3) and mesalamine (OR [per 1,000 g] 1.3, 95% CI 0.9-1.9), or partial intestinal resections (OR 1.5, 95% CI 0.3-7.1).CONCLUSIONS: Subgroups of IBD patients-those with PSC, severe long-standing disease, and exposure to x-ray-were at greater risk of colorectal neoplasia. The protective effect of close follow-up, colonoscopy, and treatment with 5-aminosalicylates was questionable.

AB - OBJECTIVES: Population-based data on risk factors and protective factors for colorectal dysplasia and cancer in patients with inflammatory bowel disease (IBD) are sparse. We conducted a nested case-control study of such factors in two well-described IBD cohorts from Copenhagen County, Denmark and Olmsted County, Minnesota.METHODS: Forty-three neoplasia cases were matched on six criteria to 1-3 controls (N = 102). Medical records were scrutinized for demographic and clinical data. For each variable, the odds of neoplasia were estimated using conditional logistic regression.RESULTS: Primary sclerosing cholangitis (PSC) (odds ratio [OR] 6.9, 95% confidence interval [CI] 1.2-40), percentage of disease course with clinically active disease (OR [per 5% increase] 1.2, 95% CI 0.996-1.4), and >or=1 yr of continuous symptoms (OR 3.2, 95% CI 1.2-8.6) were associated with neoplasia, whereas a borderline association with median number of small-bowel x-rays (OR 1.3, 95% CI 0.96-1.6) was observed. We did not observe a protective effect of frequency of physician visits (OR 1.4, 95% CI 0.96-2.0), number of colonoscopies (OR 1.4, 95% CI 1.0-2.1), cumulative dose of sulfasalazine (OR [per 1,000 g] 1.1, 95% CI 1.0-1.3) and mesalamine (OR [per 1,000 g] 1.3, 95% CI 0.9-1.9), or partial intestinal resections (OR 1.5, 95% CI 0.3-7.1).CONCLUSIONS: Subgroups of IBD patients-those with PSC, severe long-standing disease, and exposure to x-ray-were at greater risk of colorectal neoplasia. The protective effect of close follow-up, colonoscopy, and treatment with 5-aminosalicylates was questionable.

KW - Adult

KW - Case-Control Studies

KW - Colonoscopy

KW - Colorectal Neoplasms/epidemiology

KW - Denmark/epidemiology

KW - Female

KW - Gastrointestinal Agents/therapeutic use

KW - Humans

KW - Inflammatory Bowel Diseases/complications

KW - Logistic Models

KW - Male

KW - Mesalamine/therapeutic use

KW - Minnesota/epidemiology

KW - Population Surveillance

KW - Precancerous Conditions/epidemiology

KW - Prognosis

KW - Risk Factors

KW - Sulfasalazine/therapeutic use

U2 - 10.1111/j.1572-0241.2007.01070.x

DO - 10.1111/j.1572-0241.2007.01070.x

M3 - Journal article

C2 - 17222314

SN - 0002-9270

VL - 102

SP - 829

EP - 836

JO - The American Journal of Gastroenterology

JF - The American Journal of Gastroenterology

IS - 4

ER -