Certain patients with inflammatory bowel disease (IBD), both ulcerative colitis and Crohn's disease of the colon, have an increased risk of developing colorectal cancer compared to individuals without IBD. A number of factors contribute to the increase in risk, which necessitates an individualized and sensible approach to surveillance in patients, according to a new medical position statement and technical review published by the American Gastroenterological Association in its official journal, Gastroenterology.
"The increased risk of developing colorectal cancer in certain patients with IBD prompted the AGA to look at current diagnosis and management protocols to ensure that our patients are receiving the highest level of treatment," according to Francis A. Farraye, MD, primary author of the manuscript. "The recommendations we developed will help guide gastroenterologists to identify high-risk individuals and develop surveillance plans based on each patient's unique situation."
While IBD is relatively rare in the general population, it remains one of the three high-risk conditions predisposing patients to CRC, along with Lynch syndrome and familial adenomatous polyposis. "Although certain patients with IBD have an increased risk of developing colorectal cancer, there is evidence that the risk of developing cancer has decreased over the past several decades," stated senior author Steven Itzkowitz, MD.
Other findings of the medical position statement on diagnosis and management of CRC in IBD patients include:
The conclusions of the technical review and medical position statement were based on the best available evidence, or in the absence of quality evidence, the expert opinions of the authors and medical position panel convened to critique the technical review and structure the medical position statement. The technical review and the medical position statement together represent the guideline.
To develop the guidelines, a set of 10 broad questions were identified by experts in the field to encapsulate the most common management questions faced by clinicians. To review recommendations and grades, view the AGA Medical Position Statement on the Diagnosis and Management of Colorectal Neoplasia in Inflammatory Bowel Disease. The guidelines were developed through interaction among the authors, the AGA Institute, the Clinical Practice and Quality Management Committee and representatives from the AGA Institute Council.
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