Impact of Mucosal Inflammation on Risk of Colorectal Neoplasia in Patients with Ulcerative Colitis: A Systematic Review and Meta-Analysis

Publication date: Available online 24 July 2017
Source:Gastrointestinal Endoscopy
Author(s): Brisas M. Flores, Anthony OʼConnor, Alan C. Moss
Background and AimsLong-standing ulcerative colitis is an established risk factor for colorectal neoplasia. A number of observational studies have suggested that evidence of mucosal inflammation (endoscopic or histologic) is associated with a greater risk for colorectal neoplasia than is mucosal healing. Our goal was to systematically analyze the risk of colorectal neoplasia in ulcerative colitis patients with ongoing mucosal inflammation to better inform surveillance strategies.MethodsWe performed a systematic review and meta-analysis of the effect of endoscopic and/or histologic inflammation on the risk of colorectal neoplasia in cohort and case-control studies. Sensitivity analyses for study setting and case definition were performed.ResultsSix studies met the inclusion criteria, incorporating outcomes in 1,443 patients. No study used a single validated measure for mucosal inflammation. The pooled odds ratio for colorectal neoplasia was 3.5 (95% CI, 2.6 - 4.8; p < 0.001) in those with any mucosal inflammation, and 2.6 (95% CI, 1.5-4.5; p = 0.01) in those with histologic inflammation, when compared to those with mucosal healing. Overall quality of the studies was good.ConclusionsThe presence of objective evidence of mucosal inflammation during follow-up in patients with ulcerative colitis is associated with a greater risk of subsequent colorectal neoplasia than in those with mucosal healing. This risk factor should be considered in guidelines on surveillance intervals for these patients.



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