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P473 Cumulative histological inflammation predicts colorectal neoplasia in ulcerative colitis

O. V. Yvellez1, V. Rai*1, J. Hart2, J. R. Turner2, K. El Jurdi1, D. T. Rubin1

1Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, USA, 2Brigham and Women's Hospital, Pathology, Boston, MA, USA

Background

Chronic inflammation in ulcerative colitis (UC) is associated with the development of subsequent colorectal neoplasia (CRN). The group at St. Mark's Hospital (London) previously reported a novel ‘cumulative inflammatory index’ that predicted development of CRN in patients with UC.1 In this analysis, we sought to validate these findings.2

Methods

A previously described cohort of UC patients with and without CRN from the University of Chicago were matched for age at diagnosis, histological extent and disease duration (within 5 years).2 Disease severity was defined using a 6-point histology inflammatory activity (HIA) score. HIA scores were calculated for each colonoscopy by taking the mean or maximum score, respectively, of all biopsy fragments. Per the St. Mark's scoring, cumulative burden for a patient was calculated by summing each HIA score multiplied by the length of the surveillance interval in years. Persistency was defined by the number of surveillance episodes with a severity score greater than 2 divided by the total number of surveillance procedures. T-tests compared mean and maximum HIA score, assessing mean and maximum severity, cumulative burden, and persistency of inflammation in UC patients.

Results

Sixty-two UC patients (26 cases with CRN, 36 controls without CRN) were analysed. Fifty-five per cent were male, the mean disease duration was 20.6 years, the mean age at CRN diagnosis was 43.9 years (Table 1). Of the 26 cases, 6 (23%) patients had colorectal cancer, 16 (62%) had low-grade dysplasia, and 4 (15%) were indefinite for dysplasia. Using mean HIA scores we found cumulative burden to be statistically higher in patients who developed CRN (p = 0.04). Using maximum HIA scores we found cumulative burden, mean severity, and persistency to be significantly higher in cases compared with controls (p = 0.02, p = 0.03, and p = 0.01, respectively). Maximum severity was numerically larger in cases for both mean and maximum HIA scores, but did not reach significance (Table 2).

Conclusion

Cumulative histological inflammation is significantly associated with development of CRN in patients with UC. These findings support a management strategy of inflammatory disease control over time to reduce risk of CRN, and may influence selection of surveillance intervals.

Table 1. Demographics of study population (n = 62).

Table 2. Case–control inflammation severity score.

References

1 Choi CR, Al Bakir I, Ding NJ, et al. Cumulative burden of inflammation predicts colorectal neoplasia risk in ulcerative colitis: a large single-centre study. Gut. 2017;pii. doi:10.1136/gutjnl-2017-314190.

2. Rubin DT, Huo D, Kinnucan JA, et al. Inflammation is an independent risk factor for colonic neoplasia in patients with ulcerative colitis: a case–control study. Clin Gastroenterol Hepatol 201311:1601–8.e1-4