ABNORMALITIES OF THE UTERINE CERVIX IN WOMEN WITH IBD

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Purpose: To evaluate prevalence of abnormalities of the uterine cervix in women with inflammatory bowel disease (IBD) when compared to healthy controls. Methods: 93 patients with IBD [46 Crohn's disease (CD), 45 Ulcerative colitis (UC), 2 indeterminate colitis] were age matched (± two years) to 93 healthy controls. Cases and controls were of middle to high socio-economic status. Data was collected forage, race, marital status, diagnosis of IBD with duration, severity, and use of immunomodulators. Pap smear results for five years prior to enrollment were obtained and results were categorized as normal, “of unknown significance,” and abnormal (dysplasia or carcinoma). For data analysis purposes, “abnormal” and “of unknown significance” results were grouped into one category. Results: Mean age at the time of pap was 44 years (SD ± 13) and median duration of IBD was 15 years (0–55). Majority of the patients were Caucasian (90% cases vs. 82%) and married (73% vs. 63%). 58% of IBD patients had received past or concurrent immunomodulators (6-mercaptopurine, imuran, or infliximab). Univariate analysis showed a trend toward a higher occurrence of abnormal pap (9% vs. 3%) and pap “of unknown significance” (6% vs. 2%) in the IBD group as compared to the controls (p = 0.06). Severity of IBD correlated positively with abnormal pap smear (r = 0.17, p = 0.02). No significant correlation was observed between exposure to immunomodulators and age with abnormal pap results (p >0.20). Subgroup analysis for CD and UC revealed an equal distribution of abnormal pap results in the two groups (p >0.80). Multivariate analysis predicting abnormal pap results was performed using the following variables: diagnosis of IBD (present or absent), age at the time of pap test and previous or concurrent exposure to immunomodulators. The overall model tended towards significance (p = .06) although the diagnosis of IBD appeared to be the only meaningful predictor of outcome (OR = 4, 95% CI 1.23 – 14.5; p = 0.02). Conclusions: Diagnosis of IBD bears a relationship with abnormal pap smear results while age and exposure to immunomodulators do not. Women with IBD should be screened regularly with pap smears because of the possible increased prevalence of abnormal finding.