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Severity of Inflammation in Ulcerative Colitis Linked to Increased Risk of Colorectal Neoplasia

In long-term cases of ulcerative colitis, the severity of colonic inflammation is an important determinant of the risk of colorectal neoplasia, according to the findings of a new analysis.

Patients with ulcerative colitis are at increased risk of colorectal cancer, and this is widely believed to be secondary to colonic inflammation. However, the severity of colonic inflammation has not previously been identified as a risk factor.

The authors point out that "further refinement of high and low risk sub-groups of patients is highly desirable as it would allow a more appropriate allocation of resources, reducing unnecessary procedures for those at lower risk of developing colorectal cancer, whilst enabling more intensive surveillance for those patients most likely to benefit," they suggest.

Matthew Rutter, MD, with the University Hospital of North Tees, Stockton-on-Tees, Teesside, United Kingdom, and colleagues devised a case-control study of patients with long-standing extensive ulcerative colitis to examine various potential risk factors for neoplasia.

Sixty-eight cases were studied. Each case patient was matched with 2 control patients from the same surveillance population (n = 136). Segmental colonoscopic and histological inflammation was recorded by using a score of 0 (normal) to 4 (severe active inflammation). History of primary sclerosing cholangitis, family history of colorectal cancer, and smoking and drug history were also recorded.

Univariate analysis indicated that the colonoscopic (odds ratio, 2.5; P = .001) and histological (odds ratio, 5.1; P < .001) inflammation scores were highly correlated with the risk of colorectal neoplasia, the researchers report. Furthermore, no other factors reached statistical significance. On multivariate analysis, only the histological inflammation score remained significant (odds ratio, 4.7; P < 0.001).

"We have shown that in patients with longstanding extensive ulcerative colitis, the severity of colonic inflammation is an important determinant of the risk of colorectal neoplasia," Dr. Rutter and colleagues. "In future it might be possible to adjust a patient's surveillance frequency according to the severity of ongoing active inflammation," they suggest.



Gastroenterology 2004;126:451-459. "Severity of inflammation is a risk factor for colorectal neoplasia in ulcerative colitis"

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