An Updated Approach to Dysplasia in IBD

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http://www.springerlink.com/content/60036307042271t0/

An Updated Approach to Dysplasia in IBD

Journal

Journal of Gastrointestinal Surgery

Publisher

Springer New York

ISSN

1091-255X (Print) 1873-4626 (Online)

Category

2008 ssat other

DOI

10.1007/s11-y

Subject Collection

Medicine

SpringerLink Date

Wednesday, September 03, 2008

T Rubin1

(1)

University of Chicago Medical Center, 5841 S. land Ave., MC 4076, Chicago, IL 60637, USA

Received: 28 July 2008 Accepted: 8 August 2008 Published online: 3 September 2008

Abstract

Introduction Long-standing inflammation of the colorectum in ulcerative colitis (UC) and Crohn’s disease (CD) has been associated with an increased risk of subsequent dysplasia and colorectal cancer. Historically, it was described that the neoplastic transformation in these inflammatory bowel diseases (IBDs) occurred via a different biologic pathway and not by the non-IBD polyp-cancer pathway and predictable lag time of progression. Therefore, prevention strategies have focused on the detection of dysplasia in flat mucosa, and existing guidelines have recommended performance of interval surveillance colonoscopies with random biopsies to identify such lesions with proctocolectomy when they are confirmed.

Discussion The use of a new technology higher-resolution colonoscopies has led to the appreciation more recently that dysplasia in IBD may be visible with standard optical colonoscopy and can be identified in an even more sensitive manner using chromoendoscopy. Furthermore, emerging evidence favors the intuitive understanding that neoplastic transformation in IBD is linked to the degree of inflammation and that disease control may therefore modify this risk and its subsequent prevention approaches.

Conclusion Future IBD cancer prevention strategies and timing of surgery in at-risk patients will require a better understanding of this evolving field.

Keywords Dysplasia - Colorectal cancer - Inflammatory bowel disease - Chemoprevention - Aminosalicylate therapy - Chromoendoscopy

This paper was originally presented as part of the SSAT/AGA/ASGE State-of-the-Art Conference on Optimal Timing of Surgery for IBD at the SSAT 49th Annual Meeting, May 2008, in San Diego, CA. The other articles presented in the conference were Hodin RA, Introduction: Optimal Timing of Surgery for Inflammatory Bowel Diseases; McLeod RS, Ileal Pouch Anal Anastomosis: Pregnancy—Before, During and After; Sands BE, Fulminant Colitis; and Fleshman JW, Pyogenic Complications of Crohn’s Disease, Evaluation and Management.