Article

Trends in Surveillance and Management of Dysplasia in IBD

Publish date: November 8, 2022

The prevalence of IBD has nearly doubled worldwide since the early 1990s, with popularity of the Western diet and increased alcohol consumption both being implicated in this rise within the United States and other countries.^1-3 IBD serves as an important risk factor for developing colorectal cancer (CRC); risk of CRC rises from 2% 10 years after developing ulcerative colitis to 18% after 30 years.⁴

Successful bowel prep and highly skilled endoscopists are just some of the factors that affect screening results for CRC in IBD.^5,6 New technologies and drugs are changing
the treatment paradigm. Endoscopic technologies and biologics for mucosal healing have elicited this shift to a treat-to-target approach.^7-9

Because IBD is occurring in younger populations, earlier targeted treatment of the inflamed state caused by IBD also has been emphasized.¹⁰ The earlier IBD is treated and put into remission, the less risk of CRC – with studies suggesting CRC rates for such patients may be comparable to that of the general population.¹¹ As IBD prevalence increases across age groups, races and ethnicities, and geographical locations, gastroenterologists need to consider IBD as a feasible diagnosis and take action early on to mitigate their patients' risk of developing colon cancer.^4,7

Effective bowel prep is needed to carefully evaluate the mucosa for signs of dysplasia and to visualize polyps clearly.⁵ New bowel prep methods have been explored to improve consumption of prep liquids for patients.¹² A study of 515 adults assessed the traditional prep compared with a new sulfate-based method.
Along with a good cancer surveillance program for IBD, new technologies have fine-tuned treatment options and markers for healing.⁸Emphasis has been placed on mucosal healing in IBD, and newer endoscopic technologies have helped assess subtle dysplasia and allow for removal of precancerous dysplasia, avoiding major resection of the colon at a later date.⁸As well, new small molecules aim to target the inflammation of the GI tract mucosa caused by IBD.

References

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Xu F, Carlson SA, Liu Y, Greenlund KJ. Prevalence of inflammatory bowel disease among Medicare fee-for-service beneficiaries – United States, 2001-2018. MMWR Morb Mortal Wkly Rep. 2021;70(19):698-701. doi:10.15585/mmwr.mm7019a2
Rizzello F, Spisni E, Giovanardi E, et al. Implications of the westernized diet in the onset and progression of IBD. Nutrients. 2019;11(5):1033. doi:10.3390/nu11051033
Stidham RW, Higgins PDR. Colorectal cancer in inflammatory bowel disease. Clin Colon Rectal Surg. 2018;31(3):168-178. doi:10.1055/s-0037-1602237
Tariq H, Kamal MU, Sapkota B, et al. Evaluation of the combined effect of factors influencing bowel preparation and adenoma detection rates in patients undergoing colonoscopy. BMJ Open Gastroenterol. 2019;6(1):e000254. doi:10.1136/bmjgast-2018-000254
May FP, Shaukat A. Time to add the "Q" (quality) factor to postpolypectomy surveillance? Gastroenterology. 2021;160(4):1007-1009. doi:10.1053/j.gastro.2020.12.067
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van der Laan JJH, van der Waaij AM, Gabriëls RY, Festen EAM, Dijkstra G, Nagengast WB. Endoscopic imaging in inflammatory bowel disease: current developments and emerging strategies. Expert Rev Gastroenterol Hepatol. 2021;15(2):115-126. doi:10.1080/17474124.2021.1840352
Colombel JF, D'haens G, Lee WJ, Petersson J, Panaccione R. Outcomes and strategies to support a treat-to-target approach in inflammatory bowel disease: a systematic review. J Crohns Colitis. 2020;14(2):254-266. doi:10.1093/ecco-jcc/jjz131
Atia O, Harel S, Ledderman N, et al. Risk of cancer in paediatric onset inflammatory bowel diseases: a nation-wide study from the epi-IIRN. J Crohns Colitis. 2022;16(5):786-795. doi:10.1093/ecco-jcc/jjab205
Jess T, Simonsen J, Jørgensen KT, Pedersen BV, Nielsen NM, Frisch M. Decreasing risk of colorectal cancer in patients with inflammatory bowel disease over 30 years. Gastroenterology. 2012;143(2):375-381.e1. doi:10.1053/j.gastro.2012.04.016
Di Palma JA, Bhandari R, Cleveland MV, et al. A safety and efficacy comparison of a new sulfate-based tablet bowel preparation versus a PEG and ascorbate comparator in adult subjects undergoing colonoscopy. Am J Gastroenterol. 2021;116(2):319-328. doi:10.14309/ajg.0000000000001020
May FP, Shaukat A. State of the science on quality indicators for colonoscopy and how to achieve them. Am J Gastroenterol. 2020;115(8):1183-1190. doi:10.14309/ajg.0000000000000622
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Taxonera C, Olivares D, Alba C. Real-world effectiveness and safety of tofacitinib in patients with ulcerative colitis: systematic review with meta-analysis. Inflamm Bowel Dis. 2022;28(1):32-40. doi:10.1093/ibd/izab011

Environmental Factors in IBD: Diet and Stress

	Obstructive sleep apnea
	Short sleep duration
	Genetic predisposition to insomnia
	Genetic predisposition to the morning chronotype

Trends in Surveillance and Management of Dysplasia in IBD

References

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