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CRC Surveillance in Patients With IBD

CRC Surveillance in Patients With IBD

Certain patients with inflammatory bowel diseases (IBD), including ulcerative colitis and Crohn’s disease of the colon, have an increased risk of developing colorectal cancer (CRC) when compared with patients without IBD. While IBD is relatively rare in the general population, it remains one of the important high-risk conditions predisposing patients to CRC. The majority of patients with IBD will not develop CRC, but two factors that increase CRC risk have been identified: 1) CRC risk increases after 8 to 10 years of having ulcerative colitis, and 2) the more extensive the colonic involvement, the higher the CRC risk. Patients with disease limited to the rectum do not have an increased risk of CRC, while patients with ulcerative proctosigmoiditis or left sided colitis have an intermediate risk. The greatest risk is for those whose entire colon is diseased. The risks are similar for those with extensive Crohn’s colitis. An individualized and sensible approach to CRC surveillance in patients with IBD is essential. In the February 2010 issue of Gastroenterology, the American Gastroenterological Association (AGA) released a medical position statement and technical review on the diagnosis and management of colorectal neoplasia in IBD. The goal of the statement was to ensure that patients receive the highest level of treatment. The recommendations were designed to help identify high-risk individuals and develop individualized surveillance plans based on each patient’s unique situation. Assessing Risks The AGA position statement provides important information on assessing CRC risk in IBD patients. Disease duration, more extensive disease, severity of inflammation, primary sclerosing cholangitis, and a family history of sporadic CRC have all been associated with an increased risk...
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