Screening and surveillance for individuals with inflammatory bowel disease

Colorectal cancer (CRC) is a significant cause of mortality in inflammatory bowel disease (IBD). Although most studies assessing the risk of CRC in IBD have been performed in patients with ulcerative colitis (UC), there is convincing evidence that patients with Crohn's disease have a similar risk of developing neoplasia. The risk of CRC in patients with IBD is increased with early age of diagnosis, longer duration of disease, more extensive disease, primary sclerosing cholangitis, and a family history of CRC independent of IBD. Risks of CRC are decreased with sulfasalazine and 5- ASA therapy, compliance within a surveillance program, and possibly, folic acid supplementation. Surveillance colonoscopic biopsies should be performed on a regular schedule and should decrease mortality, though controversy remains regarding optimal schedules, number of biopsies, interpretation of dysplasia, and optimal management of dysplastic findings. Newer markers of neoplastic transformation are not sufficiently sensitive or specific to replace biopsy surveillance, but p53, STn, and aneuploidy measurements may be adjunctive aids in diagnosis. Identification of more sensitive and specific markers of neoplasia may aid clinicians in more accurate and cost-effective surveillance. (C) 2000 by W.B. Saunders Company.