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P136 Sporadic adenomas in IBD patients over 50 years old and average risk population – Is there a difference?

Monteiro S.*1, Cúrdia Gonçalves T.1, Boal Carvalho P.1, Dias de Castro F.1, Leite S.1, Moreira M.J.1, Cotter J.1,2,3

1Hospital da Senhora da Oliveira-Guimarães, Gastroenterology, Guimarães, Portugal 2University of Minho, School of Medicine, Braga, Portugal 3University of Minho, Associate Laboratory ICVS/3B's, Braga, Portugal

Background

Adenoma is the major precursor of colorectal carcinoma (CRC) in general population.

Patients with ulcerative colitis (UC) and Crohn's disease (CD) are at risk of developing CRC in relation to chronic inflammation. However, they can also develop adenomas, but the prevalence of sporadic adenomas in inflammatory bowel disease (IBD) patients is unknown.

Methods

We performed a retrospective medical review of all colonoscopies performed in our center in IBD patients (UC ou CD) ≥50 or more years old between January 2008 and November 2016.

The presence of colitis or proctitis was evaluated, as well as the use of IBD medication.

The prevalence of SA in IBD patients were compared with average-risk screening colonoscopy patients in a 3: 1 ratio over the same time period. The number and time intervals between colonoscopies were reviewed.

For the prevalence calculation, we considered the first colonoscopy performed ≥50 years old.

Patients with personal or family colon cancer history and personal polyp history were excluded.

Results

Two hundred and thirty-six patients with IBD, 126 male (53.4%) and 110 female (46.6%), 63.6% with UC and 36.4% with CD, performed at least one colonoscopy during the time period, 179 (75.8%) had two or more procedures during this period.

Nine hundred and fifty-three patients underwent screening colonoscopies, and 708 patients were randomly selected to comparison.

The mean patient age was 57.1 years old for those with average risk and 56.4 years old for those with IBD (p=0.22).

There were no significant statistically differences between the 2 groups regarding the variable gender.

SAs were detected in 30 patients with IBD (12.7%), 23 in UC (15.3%) and 7 in CD (8.1%) patients, and in 206 (30.3%) patients with average risk, p<0.001.

There was no significant difference in the rate of SAs according to type of IBD (UC vs CD (p=0.1) or age (p=0.98).

There were no significant statistically differences in the prevalence of SAs and the presence or absence of colic inflammation, 14.5% vs 10.5%,respectively, p=0.43.

The majority of patients with IBD took IBD medication (77.1%), most of them with mesalamine.

Conclusion

We found a significantly lower prevalence of sporadic adenomas in patients over 50 years old with IBD than in control patients. This may reflect the effect of IBD medications in stabilizing the mucosa. Further studies are needed to corroborate our findings and determine which factors in IBD influence adenoma-carcinoma sequence.