Mount Sinai Researchers: 20-Year Study Reveals Pseudopolyps Do Not Predict Neoplasia in IBD patients

Study fills gap in literature that addresses the risk of colorectal neoplasia and colectomy in patients with IBD and pseudopolyps


Newswise — (NEW YORK –December 7, 2018)  –   In a study published today in Gastroenterology, a team of researchers from the Icahn School of Medicine at Mount Sinai and elsewhere finds that there is no association between post-inflammatory polyps (PIPs), also known as pseudopolyps, and advanced colorectal neoplasia (CRN) in patients with inflammatory bowel disease (IBD).

The result could affect how IBD patients undergo screening colonoscopies. In Europe, guidelines propose that patients with PIPs receive more frequent surveillance colonoscopies, despite limited evidence of increased risk. The study results suggest that may be unwarranted.

Patients with longstanding inflammatory bowel disease (IBD) colitis are at increased risk of developing colorectal dysplasia and colorectal cancer (CRC).  CRC is one of the leading causes of mortality worldwide.   PIPs are encountered in 20-35 percent of patients with IBD and colonic involvement. Whether they are accurate predictors of colorectal neoplasia has long remained a question.  Colorectal neoplasia is a new abnormal growth, or mass, of cells, which can be benign or malignant; doctors monitor neoplasia carefully as it can be an early sign of cancer.

The team of researchers from the United States and the Netherlands conducted a multicenter study involving 1,582 eligible patients, 462 (29 percent) of whom had PIPs, at five academic hospitals and two large non-academic hospitals in the two countries. Surveillance of patients took place from January 1997 through January 2017.

The purpose of the 20-year study was to define the risk of CRN and colectomy in patients with IBD and PIPs. No previous study had addressed whether PIPs are a reliable predictor of advanced CRN. 

The researchers found that PIPs were associated with more severe inflammation, greater disease extent, and lower likelihood of primary sclerosing cholangitis, a rare and chronic disease of the liver and bile duct, but were not, in themselves, independent predictors of advanced CRN.

During a median follow-up of 4.8 years, the time until development of advanced CRN did not differ significantly between patients with PIPs and those without. PIPs did not independently increase the risk of advanced CRN (adjusted hazard ratio, 1.17; 95 percent CI, 0.59-2.31).  The colectomy rate was significantly higher in patients with PIPs (P=0.01), possibly because colectomies were being done for medically refractory disease (ongoing inflammation, not neoplasia). More colectomies were done in the Netherlands than at Mount Sinai, likely reflecting different practice patterns.

 “This is very good news for the IBD patient with pseudopolyps, as their surveillance colonoscopies will likely be affected by these results. We hope that doctors treating these IBD patients would be less fearful of colon cancer risk in a colon with PIPs, and forego shortened intervals of surveillance as a result of our findings, lending to improved quality of life and lower healthcare costs,” says corresponding author Steven Itzkowitz, MD, Professor of Medicine and Oncological Sciences, and Director of the GI Fellowship Program at the Icahn School of Medicine at Mount Sinai. 


About the Mount Sinai Health System

The Mount Sinai Health System is New York City's largest integrated delivery system encompassing (with the addition of South Nassau Communities Hospital) eight hospital campuses, a leading medical school, and a vast network of ambulatory practices throughout the greater New York region. Mount Sinai's vision is to produce the safest care, the highest quality, the highest satisfaction, the best access and the best value of any health system in the nation. The Health System includes approximately 7,480 primary and specialty care physicians; 11 joint-venture ambulatory surgery centers; more than 410 ambulatory practices throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and 31 affiliated community health centers. The Icahn School of Medicine is one of three medical schools that have earned distinction by multiple indicators: ranked in the top 20 by U.S. News & World Report's "Best Medical Schools", aligned with a U.S. News & World Report's "Honor Roll" Hospital, No. 12 in the nation for National Institutes of Health funding, and among the top 10 most innovative research institutions as ranked by the journal Nature in its Nature Innovation Index. This reflects a special level of excellence in education, clinical practice, and research. The Mount Sinai Hospital is ranked No. 18 on U.S. News & World Report's "Honor Roll" of top U.S. hospitals; it is one of the nation's top 20 hospitals in Cardiology/Heart Surgery, Gastroenterology/GI Surgery, Geriatrics, Nephrology, and Neurology/Neurosurgery, and in the top 50 in six other specialties in the 2018-2019 "Best Hospitals" issue. Mount Sinai's Kravis Children's Hospital also is ranked nationally in five out of ten pediatric specialties by U.S. News & World Report. The New York Eye and Ear Infirmary of Mount Sinai is ranked 11th nationally for Ophthalmology and 44th for Ear, Nose, and Throat. Mount Sinai Beth Israel, Mount Sinai St. Luke's, Mount Sinai West, and South Nassau Communities Hospital are ranked regionally.


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Journal Link: Gastroenterology