Serrated Epithelial Change Is Associated With High Rates of Neoplasia in Ulcerative Colitis Patients: A Case-controlled Study and Systematic Review With Meta-analysis

Abstract

Background Patients with long-standing ulcerative colitis (UC) are at an increased risk of colorectal cancer. Risk stratification is important to identify patients who require more frequent endoscopic surveillance. Serrated epithelial change (SEC) found in patients with long-standing colitis may be associated with neoplasia and serve as a marker to stratify patients at higher risk of colorectal cancer (CRC). Methods A case-control study was performed to compare the rates of neoplasia between UC patients with SEC and UC patients without SEC who were matched for age, disease duration, and disease extent. Paired tests, conditional logistic regression, and Kaplan-Meier analyses were used to compare groups. A systematic review with meta-analysis was performed, combining our local data with previously published data. Results This study included 196 UC patients without prior neoplasia, 98 with SEC and 98 without SEC. Ulcerative colitis patients with SEC had a significantly higher rate of synchronous or metachronous neoplasia than UC patients without SEC (26.5% vs 3.1%; P < 0.001). Synchronous or metachronous high-grade dysplasia and CRC were found more frequently in UC patients with SEC than UC patients without SEC (11.2% vs 2.0%; P = 0.02). A meta-analysis was consistent with these findings, showing a higher rate of neoplasia in patients with SEC compared with those without SEC (16.4% vs 3.9%; P < 0.001). Conclusion Serrated epithelial change is associated with a significantly increased risk of synchronous and metachronous neoplasia including high-grade dysplasia and CRC in patients with UC. Histopathological findings of SEC should warrant closer endoscopic surveillance for CRC.

In vivo evidence of the prevents DSS-induced colitis of Lactiplantibacillus plantarum L15

“…Ulcerative colitis is an acute inflammatory condition triggered by several factors, and its prevalence in younger people has increased in recent years. In addition, the WHO has noted that it has a high recurrence rate that presently has no effective therapy ( Jb et al, 2013 ; Conrad et al, 2014 ; Parian et al, 2020 ). Interestingly, some trial sessions to assess the IBD-ameliorating potentials of L. plantarum have been suggested.…”

Colorectal Cancer in Inflammatory Bowel Disease: Mechanisms and Management

“…In patients with UC, those with lesions that have been referred to as "serrated epithelial change" (SEC) had an approximately 4-fold greater overall risk of subsequent neoplasia compared with no SEC, and SEC was detected most often by random biopsy of flat mucosa (66%). 43 Until more is known about the natural history of nonconventional dysplasia in IBD, it is not clear how to integrate these lesions into clinical surveillance and management decisions.…”

Alleviative Effects of Exopolysaccharide Produced by Lactobacillus helveticus KLDS1.8701 on Dextran Sulfate Sodium-Induced Colitis in Mice

“…In recent years, incidences of ulcerative colitis have increased significantly, and the disease population tends to be younger. The World Health Organization recognizes it as one of the refractory diseases and prone to recurrent attacks [26][27][28]. At present, there is no effective and suitable drug for the treatment of UC.…”