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Background Immunosuppression is a mainstay of therapy for both induction and maintenance of remission for inflammatory bowel disease (IBD). Women who are chronically immunosuppressed have been shown to be at higher risk of developing cervical high-grade dysplasia and/or carcinoma. There is contradictory data whether immunosuppressed patients with IBD have the same risk profile for cervical cancer as patients with solid organ transplant or HIV infection. Objective To determine if the risk of cervical high-grade dysplasia and/or cancer is higher in patients with IBD on immunosuppressive therapy compared to the rates in the general population. Methods The studies were restricted to full text retrospective cohort studies and case controls that had a high (6-9) Newcastle- Ottawa Score. Results All pooled analyses were based on a random effects model. Five cohort studies and three case control studies of patients with IBD on any immunosuppression with cervical high-grade dysplasia/cancer (n=995) were included in the meta-analysis. The total IBD population in these studies was 77,116. IBD patients had an increased risk of cervical high-grade dysplasia/cancer compared to healthy controls (OR= 1.34, 95% CI: 1.23-1.46). Heterogeneity was detected (I2 = 34.23, Q= 10.64, df = 7; p = 0.15). The source was found to be the type of study, as well as the OR presented (crude vs. adjusted). Conclusions There is sufficient evidence to suggest an increased risk of cervical high-grade dysplasia/cancer in patients with IBD on immunosuppressive medications compared to the general population. Given this increased risk, increased screening intervals are indicated.

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