Colon to Rectum
J Crohns Colitis. 2023;17(9):1395–409
Inflammatory bowel disease and risk of colorectal polyps: A nationwide population-based cohort study from Sweden
Background: Inflammatory bowel disease (IBD) has been linked to an increased risk of colorectal neoplasia. However, the types and risks of specific polyp types in IBD are less clear.
Methods: The authors identified 41,880 individuals with IBD (Crohn’s disease [CD], n = 12,850; ulcerative colitis [UC], n = 29,030]) from Sweden matched with 41,880 reference individuals. Using Cox regression, they calculated adjusted hazard ratios (aHRs) for neoplastic colorectal polyps (tubular, serrated/sessile, advanced and villous) defined by histopathology codes.
Results: During follow-up, 1648 IBD patients (3.9%) and 1143 reference individuals (2.7%) had an incident neoplastic colorectal polyp, corresponding to an incidence rate of 46.1 and 34.2 per 10,000 person-years, respectively. This correlated to an aHR of 1.23 (95% confidence interval [CI]: 1.12–1.35) with the highest HRs seen for sessile serrated polyps (8.50, 95% CI: 1.10–65.90) and traditional serrated adenomas (1.72, 95% CI: 1.02–2.91). aHRs for colorectal polyps were particularly elevated in those diagnosed with IBD at a young age and at 10 years after diagnosis. Both absolute and relative risks of colorectal polyps were higher in UC than in CD (aHRs = 1.31 vs. 1.06, respectively), with a 20-year cumulative risk difference of 4.4% in UC and 1.5% in CD, corresponding to 1 extra polyp in 23 patients with UC and 1 in 67 CD patients during the first 20 years after IBD diagnosis.
Conclusions: In this nationwide population-based study, there was an increased risk of neoplastic colorectal polyps in patients with inflammatory bowel disease (IBD). Colonoscopic surveillance in IBD appears important, especially in ulcerative colitis and after 10 years of disease.