Colorectal cancer among inflammatory bowel disease patients: risk factors and prevalence compared to the general population

Abstract

BackgroundColorectal cancer (CRC) is a feared complication of inflammatory bowel disease (IBD). We aimed to investigate the prevalence and risk factors of CRC among a large cohort of IBD patients.MethodsData on IBD patients free of CRC at baseline was extracted using the MDClone platform of the Clalit health maintenance organization in Israel. We investigated the frequency rate of CRC among IBD patients compared to a control group without IBD. Possible risk factors, including comorbidities and IBD-related medications, were investigated in a multivariate analysis.ResultsDuring a follow-up of 139,448 years among Crohn’s disease (CD) patients and 139,533 years among ulcerative colitis (UC) patients, a frequency rate of CRC was 1.5% (191) among 12,888 CD patients and 2.1% (261) among 12,381 UC patients compared to 1.2% among 57,334 controls. In a multivariate analysis of UC patients, age at diagnosis (OR 1.030, p < 0.001), primary sclerosing cholangitis (OR 2.487, p = 0.005), diabetes mellitus (OR 2.01, p < 0.001), and glucocorticoids treatment (OR 1.465, p = 0.008) were found to be predictors of CRC. For CD patients, age at diagnosis (OR 1.035, p < 0.001), primary sclerosing cholangitis (OR 2.25, p = 0.029), and glucocorticoids treatment (OR 2.07, p < 0.001) were found to be predictors for CRC, but not diabetes mellitus.ConclusionDespite the continuously decreasing rates of CRC among IBD patients, these are still higher in IBD patients compared to the general population. IBD patients, particularly those with risk factors, require special consideration in follow-up for CRC.

Intestinal Dysbiosis: Microbial Imbalance Impacts on Colorectal Cancer Initiation, Progression and Disease Mitigation

“…Research has confirmed the relationship between fungal dysbiosis and IBD, including a decreased prevalence of S. cerevisiae and an increased presence of Candida albicans [18]. Importantly, the prevalence of colitis-associated CRC has decreased in recent years due to improved therapeutic options and increased surveillance for CRC in IBD patients [33].…”

“…Sporadic CRC (not associated with familial or inherited factors) is associated with chronic IBD, particularly UC, inactive lifestyles, poor diet, and alcohol [38]. Chronic inflammation, as present in IBD patients, is associated with incidences of CRC [33]. Crohn's disease of the ileocolic region, for example, may increase CRC risk.…”

Matrix metalloproteinases as biomarkers and therapeutic targets in colitis-associated cancer

“…IBD is associated with a two- to three-fold increased risk of CRC, a major cause of IBD mortality and need for colectomy ( 76 ). The frequency rate of CAC is 1.78% among IBD patients (2.1% for ulcerative colitis and 1.5% for Crohn’s disease), while the rate of CRC is 1.23% in the general population ( 77 ). Notably, in line with the decreasing mortality from CRC in the United States, the rates of CAC incidence and mortality also appear to be declining.…”

Krill Oil and Its Bioactive Components as a Potential Therapy for Inflammatory Bowel Disease: Insights from In Vivo and In Vitro Studies

“…Frequent complications associated with disease progression in CD are abscess and stricture formation, intestinal obstruction, and fistulas [4]. Moreover, patients with IBD have a higher risk of developing other complications, such as asthma or bronchitis, psoriasis, pericarditis, ischemic heart disease, and colon carcinoma [7][8][9][10]. Several key factors are related to the development of IBD, including genetic components (over 240 nonoverlapping genetic risk loci), environmental elements (e.g., smoking, diet, drugs, geography, social stress, and psychological elements), microbial dysbiosis, and altered immune responses [11,12].…”