This uncommissioned review article was subject to full peer-review.
Review article: colorectal neoplasia in patients with primary sclerosing cholangitis and inflammatory bowel disease
Article first published online: 22 JUN 2011
© 2011 Blackwell Publishing Ltd
Alimentary Pharmacology & Therapeutics
Volume 34, Issue 5, pages 497–508, September 2011
How to Cite
Torres, J., de Chambrun, G. P., Itzkowitz, S., Sachar, D. B. and Colombel, J.-F. (2011), Review article: colorectal neoplasia in patients with primary sclerosing cholangitis and inflammatory bowel disease. Alimentary Pharmacology & Therapeutics, 34: 497–508. doi: 10.1111/j.1365-2036.2011.04753.x
- Issue published online: 2 AUG 2011
- Article first published online: 22 JUN 2011
- Publication data Submitted 18 May 2011 First decision 1 June 2011 Resubmitted 3 June 2011 Accepted 6 June 2011 EV Pub Online 22 June 2011
Aliment Pharmacol Ther 2011; 34: 497–508
Background Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease strongly associated with inflammatory bowel disease (IBD). IBD patients diagnosed with PSC have an increased risk of colorectal dysplasia and cancer.
Aims To review the available evidence regarding colorectal neoplasia epidemiology, preventive strategies and outcomes in patients with PSC and IBD, and to advance some hypotheses regarding possible mechanisms involved in cancer pathogenesis in these patients.
Methods A PubMed search was conducted for the English language publications with predetermined search criteria. Reference lists from studies selected were manually searched to identify further relevant reports. Relevant manuscripts considering colorectal neoplasia in patients with PSC-IBD were selected.
Results Primary sclerosing cholangitis increases the risk of colorectal neoplasia in patients with ulcerative colitis; fewer data are available for Crohn’s disease. PSC-IBD patients tend to be younger at diagnosis of IBD and at diagnosis of colorectal cancer. Colorectal cancer in PSC-IBD patients predominates in the right colon. The increased risk of neoplasia is maintained after liver transplant and proctocolectomy. The role of ursodeoxycholic acid as a chemopreventive agent is controversial. The mechanisms underlying increased risk of colorectal neoplasia in these patients remain unknown.
Conclusions A more comprehensive understanding of the mechanisms involved in colorectal neoplasia development in PSC-IBD patients is needed. Until then, early cancer detection through enrolment in surveillance programmes is the only available strategy to decrease cancer risk.