Risk, protective factors for advanced colorectal neoplasia in IBD patients

Among patients with inflammatory bowel diseases (IBDs), low-grade dysplasia (LGD), ulcerative colitis (UC; as opposed to Crohn’s disease [CD]), primary sclerosing cholangitis (PSC), and an extensive disease seem to aggravate the risk of advanced colorectal neoplasia (aCRN), reports a recent meta-analysis.

On the other hand, surveillance and specific medications seem to mitigate such risks.

From the databases of PubMed and Embase, a total of 164 eligible studies were retrieved, allowing for a pooled analysis of 31 potential predictive factors. Most (n=120) of the studies were cohort studies, while the remaining were case-controlled. The Quality in Prognosis Studies tool deemed 83 studies to have low risk of bias, while the risk was high in 49.

The overall synthesis found that there was strong univariable evidence to support extensive disease as a significant risk factor for aCRN in IBD patients (odds ratio [OR], 2.43, 95 percent confidence interval [CI], 2.01–2.93). Multivariable analysis found no risk factor with strong evidence, which was defined as a risk estimate ≥2 (or ≤0.5 for protective factors), low heterogeneity, and with ≥5 studies in pooled analysis.

There was moderate evidence of PSC (OR, 4.14, 95 percent CI, 2.85–6.01), UC (vs CD: OR, 1.50, 95 percent CI, 1.09–2.06), and LGD (OR, 10.85, 95 percent CI, 5.13–22.97) as univariable risk factors for aCRN.

On the other hand, surveillance colonoscopies (OR, 0.39, 95 percent CI, 0.23–0.66), the use of 5-aminosalicylic acid (OR, 0.53, 95 percent CI, 0.39–0.72), and thiopurines (OR, 0.55, 95 percent CI, 0.37–0.82) were all protective, with moderate level of evidence.