Presentations at Crohn’s & Colitis Congress 2024 focused on several topics, including medical manage – ment of IBD, gaps in IBD monitoring, and surgical concepts.
A separate study published in The American Journal of Gastroenterology examined a topic that incor – porates a number of these areas. Sidhartha Sinha, MD, and colleagues aimed to determine whether patients with quiescent IBD who undergo colonoscopy for colorectal cancer surveillance experience a higher risk for IBD flare.
In the paper, they wrote: “Patients with IBD have an approximately 3-fold increased risk of colorectal cancer death and undergo frequent surveillance via colonoscopy. Anecdotal evi – dence and small studies suggest an increased risk of flare after colonoscopy. However, we lack data from large studies.”
The retrospective, self-controlled study included adult men and women with ulcerative colitis or Crohn’s disease. The researchers included only patients who underwent colonoscopy for colorectal cancer screening or surveillance. A composite of ED visit or hospitalization for IBD served as the primary outcome. Rates of steroid prescriptions were measured as a sec – ondary outcome. Both outcomes were assessed by comparing the 30-day period before colo – noscopy with the 30-day period after.
Increase in Disease Activity Seen After Colonoscopy
The analysis included 1,982 patients. More than one-half were women (n=1,050) and the median age was 42.6.
Patients with inactive IBD who underwent colonoscopy were more likely to present to the ED or require hospitalization for IBD following the procedure (incident rate ratio [IRR], 2.76; P<0.001).These patients were also more likely to receive a steroid prescrip – tion within 30 days of colonoscopy (IRR, 2.01; P<0.001).
“Potential mechanism for this association includes alterations in the gut microbiome and activation of immune pathways by bowel preparation agents,” wrote Dr. Sinha and colleagues.
They also wrote that, due to the increased risk for death from colorectal cancer among patients with IBD, “further work should be undertaken to understand if patients who experience active disease after colonoscopy are less likely to complete to future [colorectal cancer] surveillance colonoscopy.”