Chronic Hepatitis C as a Risk Factor for Colonic Neoplasia in a Community Setting

Abstract

Introduction: Evidence indicates that patients with chronic hepatitis C (CHC) have an increased risk of neoplasia. Data from tertiary referral centers suggests that HCV may be an independent risk factor for colonic neoplasia. However, the link between colon cancer and CHC in a community setting has not been extensively studied. The goal of this study was to determine if patients with CHC undergoing colonoscopies have an increased risk of colonic neoplasia. Methods: Colonoscopy data were retrospectively collected and compared for patients with CHC and controls who underwent screening (N=370) and surveillance (N=126) between 1993 and 2016. Patients were matched for age, sex, and race. Data based on polyp size and histology was collected. Regression analysis was applied. Results: The screening data consists of 185 patients with CHC and 185 non-hepatitis controls. The surveillance data consists of 67 CHC and 59 controls. Screening data analysis indicated that patients with CHC had a greater number of adenomas in comparison to controls (70% vs 45%; pntrols (31% vs 19%; p< 0.05, respectively). CHC and male sex were found to be independent risk factors for colonic neoplasia on regression analysis. The odds of having polyps in CHC patients was 255% higher than in controls (odds ratio 3.55, 95% confidence interval [CI]: 2.16, 5.94). In the surveillance data, the total number of patients with polyps was higher in the CHC group than in controls (70% vs 47%, p < 0.05). The CHC group also had a higher proportion of patients with tubular adenomas (61% vs 46%, p=0.12). The CHC group had a trend of having polyps larger than 0.75 cm in comparison to controls (25% vs 19%, p=NS). Surveillance data regression analysis revealed CHC as an independent risk factor for the development of colonic neoplasia. The odds of having polyps for CHC patients were 227% higher than in controls (odds ratio 3.27, 95% CI: 1.37, 8.25). Conclusion: This study concludes an association between HCV infections, increased numbers of polyps and more advanced neoplasia in patients undergoing screening colonoscopy. CHC patients undergoing surveillance had greater odds of polyp formation than controls. Further research should decide if this high risk population should undergo screening earlier and/or at decreased intervals.