All Patients with Chronic Hepatitis C Over the Age of 50 Should Have Screening Colonoscopy Prior to Interferon Therapy

Abstract

All Patients with Chronic Hepatitis C Over the Age of 50 Should Have Screening Colonoscopy Prior to Interferon Therapy Ramesh Koka, Gaurav Mehta, Victor Araya, Kenneth D. Rothstein Background: The prevalence of polyps on screening colonoscopy has been well studied in patients with cirrhosis and as part of pre-transplant evaluation. Recent studies have indicated that there might be an increased prevalence in cirrhotics especially in the age group ! 50 with prevalence rates of up to 40%. There have been no studies examining the prevalence of polyps or colorectal cancer specifically in patients with chronic hepatitis C. Aim: Our goal was to examine the prevalence of polyps in patients with chronic hepatitis C to determine if there was an increase compared to the average risk population. Methods: Retrospective database review identified 181 screening colonoscopies performed in patients with chronic hepatitis C between 1998 & 2004. Histological data on the polyps removed were also examined. Results: 181 screening colonoscopies were performed, 42 were excluded for repeat colonoscopy, rectal bleeding, or prior history of polyps. Of the 139 analyzed, 86 were men & 53 were women. 56/139 (40%) had polyps of which 24/139 (17%) had tubular adenomas. Other pathologies noted at colonoscopy included diverticulosis, AVMs and hemorrhoids. No cancers or dysplasia was recorded in this group of patients. Men had 17/86 (19.7%) had tubular adenomas compared to women 7/53(13%). When subdivided by race, Caucasians (W) had higher rates of tubular adenomas 9/43(21%) compared to African Americans (AA) 12/82 (14.6%). Conclusions: The prevalence of polyps in patients with chronic hepatitis C in our study is comparable to that of the asymptomatic average risk population (24-47%) though the mean age was lower than in prior studies (56 compared to 62.5). Since the incidence of polyps increases with advancing age, this study suggests that patients with chronic hepatitis C may have a higher prevalence of colonic polyps. All patients with chronic hepatitis C over the age of 50 should be screened with colonoscopy prior to treatment given the significant prevalence of colon polyps, especially tubular adenomas. Abstracts