IBD high risk groups

Transcription

1 IBD high risk groups

2 Ulcerative colitis

3 Value (95% CI) CRC prevalence (%) 3.7 ( ) Overall annual CRC incidence (%) 0.3 ( ) Annual CRC incidence in first decade of UC (%) 0.2 ( ) Annual CRC incidence in second decade of UC (%) 0.7 ( ) Annual CRC incidence in third decade of UC (%) 1.2 ( ) Eaden, JA et al. Gut 2001; 48:

4 Population-based studies Study Location Dates Person-year Inc. Relative risk (%) (95% CI) Palli et al 1 Italy ( ) Winther et al 2 Denmark ( ) Bernstein et al 3 Canada ( ) Lakatos et al 4 Hungary Jess et al 5 Minnesota ( ) 1-Palli, D et al. Gastroenterol 2000; 119: ; 2-Winther, KV et al. Gastroenterol 2003; 125: Bernstein, CN et al. Cancer 2001; 91: ; 4-Lakatos, L et al. Inflam. Bowel. Dis. 2006; 12: Jess, T et al. Gastroenterol 2006;130:

5 Ulcerative colitis Disease duration Extent of inflammatory bowel disease Age at onset Family history Primary Sclerosing cholangitis (PSC) Severity of inflammation Dysplasia

6 Ulcerative colitis Disease duration Extent of inflammatory bowel disease Age at onset Family history Severity of inflammation Primary Sclerosing cholangitis (PSC) Dysplasia

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8 Copenhagen N=783 Diagnosis: Observation: 6.7 years (1-18) Cumulative colectomy rate (18 years): 31% Annual risk CRC: 0.07% Cumulative risk after 18 years: 1.4% ( ) Hendriksen, C et al. Gut 1985; 26:

9 Copenhagen N=1161 Diagnosis: till 1987 Observation: 11.7 years (0-26) Cumulative colectomy rate (25 years): 32.4% Cumulative risk after 25 years: 3.1% ( ) Langholz, E et al. Gastroenterol 1992; 103:

10 Ulcerative colitis Disease duration Extent of inflammatory bowel disease Age at onset Family history Primary Sclerosing cholangitis (PSC) Severity of inflammation Dysplasia

11 Gyde et et al. Gut 1998; 29:

12 Ulcerative colitis Disease duration Extent of inflammatory bowel disease Age at onset Family history Severity of inflammation Primary Sclerosing cholangitis (PSC) Dysplasia

13 Age at onset UC Age groups (years) Male IRR Female IRR All IRR Birth 39 years 17.3 ( ) 7.64 ( ) 12.4 ( ) years 3.37 ( ) 1.62 ( ) 2.44 ( ) 60 + years 2.12 ( ) 2.05 ( ) 2.09 ( ) Total 3.17 ( ) 2.16 ( ) 2.71( ) Bernstein CN et al. Cancer 2001;91;854-62

14 Age at onset UC Age groups Duration Disease Observed Expected SIR 95% CI 0 29 years < 14 yr > 15 yr years < 14 yr > 15 yr > 50 years < 14 yr > 15 yr Karlén P et al. Am J Gastroenterol 1994;94;

15 Gyde et et al. Gut 1998; 29:

16 Ulcerative colitis Disease duration Extent of inflammatory bowel disease Age at onset Family history Severity of inflammation Primary Sclerosing cholangitis (PSC) Dysplasia

17 Family history Family history CRC O E SIR (95% CI) RR (95%CI) All patients Total (12-17) NO (11-17) 1 Yes (16-52) 2.5 ( ) UC Total (16-24) NO (15-23) 1 Yes (15-68) 2.0 ( ) Askling J et al. Gastroenterol 2001;

18 Ulcerative colitis Disease duration Extent of inflammatory bowel disease Age at onset Family history Primary Sclerosing cholangitis (PSC) Severity of inflammation Dysplasia

19 PSC PSC- UC (n=58) Years CRC risk (%) UC (n=40) CRC risk Years (%) Broome, U et al. Hepatology 1995; 22:

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21 Ulcerative colitis Disease duration Extent of inflammatory bowel disease Age at onset Family history Primary Sclerosing cholangitis (PSC) Severity of inflammation Dysplasia

22 Normal Mucosa Inflammation Carcinoma

23 Severity of inflammation 3 P<0.001 Score of inflammation p=0.001 Colonoscopic inflammation Histological inflammation 0 Controls UC-Carcinoma Rutter et al. Gastroenterol 2004;126:

24 Severity of inflammation Variable Group odds ratio (95% CI) p value Normal colonic no 1 yes 0.38 ( ) Inflammatory polyps no 1 yes 2.29 ( ) Colonic stricture no 1 yes 4.62 ( ) 0.05 Rutter MD et al. Gut 2004;

25 Ulcerative colitis Disease duration Extent of inflammatory bowel disease Age at onset Family history Primary Sclerosing cholangitis (PSC) Severity of inflammation Dysplasia

26 Normal Mucosa Inflammation Dysplasia

27 Dysplasia Probability of finding cancer If colectomy done Immediately After follow-up Low-grade 1 3/16 (19%) 17/204 (8%) Low-grade 2 2/11 (19%) Low-grade 3 2/10 (20%) 7/36 (19%) 1-Bernstein et al. Lancet 1994; 343: 71-4 ; 2-Ullman et al. Gastroenterol 2003;125: Rutter, DR et al. Gastroenterol 2006; 130:

28 Dysplasia Progression of LGD to HGD or cancer Year Hospital LGD (n) Rate Connel et al St. Marks 9 54% - 5 years Ullman et al M. Sinai 46 53% - 5 years Rutter et al St. Marks 47 23% - 5 years Lindberg et al Huddinge 37 35% - 20 years Lim et al Leeds,UK 29 10% - 10 years 1-Connel et al. Gastroenterol 1994 ; 2-Ullman et al. Gastroenterol 2003;125: Rutter, DR et al. Gastroenterol 2006; 4- Lindber et al. Scand J Gastroenterol 1996;31: ;5-Lim et al.

29 Dysplasia Probability of finding cancer If colectomy done Immediately After follow-up DALM 1 17/40 (43%) - High-grade 1 10/24 (42%) 15/47 (32%) High-grade 2 8/12 (67%) - High-grade 3 5/11 (46%) 2/ 8 (25%) 1-Bernstein et al. Lancet 1994; 343: 71-4 ; 2-Connel et al. Gastroenterol 1994; 107: Rutter, DR et al. Gastroenterol 2006; 130:

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31 Crohn s disease

32 Canavan et al. Alimentary Pharmacol Thera 2006;23;

33 Crohn s disease Colonic disease Study N Colonic Disease CRC (n=) SIR or RR SIR or RR (colonic disease) Weedon et al ( ) NR Gyde et al (p<.001) 23.8(p<.001) 1980 Greenstein et al NR 6.9 (p<.001) 1981 Gillen et al ( ) Ekbom et al ( ) 5.6( ) 1990 Jess et al ( ) 0.8( ) 2006 Friedman S. Gastroenterol Clin N Am 2006;35;

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35 CD Young age at onset Study N Colonic Disease CRC (n=) SIR or RR SIR or RR (colonic disease) Weedon et al Gyde et al ( ) NR 4.3 (p<.001) 23.8(p<.001) Greenstein et al NR 6.9 (p<.001) 1981 Gillen et al 281 Only patients 214 < 21 years 8 at onset of CD 3.4( ) Ekbom et al ( ) 5.6( ) 1990 Jess et al ( ) 0.8( ) 2006 Weedon Dd et al. N E J Med 1973;289;

36 CD Young age at onset Study N Colonic Disease CRC SIR or RR SIR or RR Age of onset (n=) CRC Risk (colonic disease) < Weedon 30 yr et al ( ) ( ) NR 1973 > 30 yr 2.2 ( ) Gyde et al (p<.001) 23.8(p<.001) 1980 Greenstein et al NR 6.9 (p<.001) Ekbom et al. Lancet 1990;336: Gillen et al ( ) Ekbom et al ( ) 5.6( ) 1990 Jess et al ( ) 0.8( ) 2006

37 CD Young age at onset Study N Colonic Disease CRC SIR or RR SIR or RR Age at onset (n=) CRC Risk (colonic disease) Weedon < 30 etyr al ( ) ( ) NR 1973 Gyde et al (p<.001) 23.8(p<.001) 1980 Greenstein et al NR 6.9 (p<.001) 1981 Jess T et al. Gastroenterol 2006;130: Gillen et al ( ) Ekbom et al ( ) 5.6( ) 1990 Jess et al ( ) 0.8( ) 2006 Friedman S. Gastroenterol Clin N Am 2006;35;

38 CD Extent of disease Extensive CD (n=125) CRC risk 22 years 8% Extensive UC (n=486) CRC risk 20 years 7% Gillen CD et al. Gut 1994; 35:

39 CD Duration of the disease CD (n=314) CRC risk Years (%) CD CRC risk Years (%) 1-Jess T et al. Gastroenterol 2006; 130: Canavan et al. Alimentary Pharmacol Therap. 2006; 23:

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41 Dysplasia Distant dysplasia in CRC Patients with CRC Patients with distant dysplasia Craft et al 2 2(100%) Simpson et al 3 1(33%) Petras et al 6 4(67%) Cooper et al 2 1(50%) Hamilton et al 10 6(60%) Richards et al 5 5(100%) Stahl et al 22 6(27%) Sigel et al 19 9(41%) Adapted from Ullman. J Clin Gastroenterl 2003;36:s76

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44 Strictures % OF MALIGNANT STRCTURES N= >20 Years of Crohn s disease Yamazaki Y et al. Am J Gastroenterol 1991;86:

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46 CD Ulcerative colitis Disease duration Colonic disease Age at onset Dysplasia Stenosis Diversion segment Disease duration Extent of inflammatory bowel disease Age at onset Family history Primary Sclerosing cholangitis (PSC) Severity of inflammation Dysplasia

47 IBD high risk groups Minor risk Mild disease activity High risk group Chronic active Severe activity PSC Chronic active Severe activity Young age onset Long duration Total colectomy