Clinical Characteristics of Crohn's Disease-Associated Cancer with a Focus on Endoscopic Surveillance.

Patients with longstanding inflammatory bowel disease are at high risk of developing intestinal cancers. In this study, we aimed to elucidate the differences between intestinal cancers associated with ulcerative colitis and Crohn's disease. Intestinal cancers in ulcerative colitis and Crohn's disease patients treated between 1983 and 2020 at 43 Japanese institutions were retrospectively analyzed.. A total of 1505 intestinal cancers in 1189 ulcerative colitis and 316 Crohn's disease patients were studied. Almost all of ulcerative colitis-associated cancers (99%) were in the colon and rectum, whereas half of Crohn's disease-associated cancers (44%) were in the anus, with 11% in the small intestine. Ulcerative colitis-associated cancers were diagnosed more frequently by surveillance (67% vs. 25%, P < 0.0001) and at earlier stages (stages 0-1, 71% vs. 27%, P < 0.0001) compared with Crohn's disease-associated cancers. Colorectal cancers associated with Crohn's disease showed a significantly worse 5-year overall survival rate than those associated with ulcerative colitis (stage 2, 76% vs. 89%, P = 0.01, stage 3, 18% vs. 68%, P = 0.0009, and stage 4, 0% vs. 13%, P = 0.04). Surveillance correlated with earlier diagnoses for ulcerative colitis- and Crohn's disease-associated intestinal cancers, whereas shorter intervals between endoscopic examinations correlated with an earlier cancer diagnosis in ulcerative colitis patients but not in Crohn's disease patients. The clinical and oncological features of ulcerative colitis- and Crohn's disease-associated cancers were very different. Crohn's disease-associated cancers were diagnosed at more advanced stages and were detected less frequently by surveillance. Additionally, they showed a significantly poorer prognosis.

Corticosteroid Therapy in the Age of Infliximab: Acute and 1-Year Outcomes in Newly Diagnosed Children With Crohn’s Disease

Background/Aims: Crohn's disease (CD) is an inflammatory bowel disease. The risk of colorectal cancer (CRC) is increased in patients with CD. In Japan, anorectal cancer accounted for >60% of CRCs associated with CD. These anorectal cancers are typically diagnosed in advanced stages, because a surveillance protocol remains to be established. This study aimed to assess various biopsy methods for detecting CRC. Methods: This study included 72 patients (113 examinations) with CD who underwent cancer surveillance between August 2008 and October 2015. Surveillances were performed with a core needle biopsy in perianal regions (54 cases), endoscopic biopsy (90 cases), and excisional biopsy (34 cases). When it was difficult to perform colonoscopy in an outpatient setting, due to perianal pain or stricture, we employed examinations under anesthesia for surveillance. Results: The total CRC detection rate was 6.19% (7 examinations). CRC detection rates were 1.85% (1 case) with core needle biopsy, 5.56% (5 cases) with endoscopic biopsy, and 5.88% (2 cases) with excisional biopsy. Conclusions: We showed that it was important to employ various biopsy methods in cancer surveillance to detect CRC among patients with CD.

Correlation between soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) expression and endoscopic activity in inflammatory bowel diseases

The Role of Endoscopy in the Management of Postoperative Patients with Crohn’s Disease

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BackgroundWhether the disease activity of ulcerative colitis (UC) and Crohn’s disease (CD) is correlated with the severity of coronavirus disease 2019 (COVID-19) remains poorly investigated with only few selected cohort studies having addressed this in the past.MethodsWe conducted a population-based study investigating the outcomes of COVID-19 among patients with UC and CD in Denmark. The Danish COVID-19 IBD Database is an extensive population-based database which prospectively monitors the disease course of laboratory-confirmed COVID-19 among patients with UC and CD. Severe COVID-19 was defined as COVID-19 necessitating intensive care unit admission, ventilator use, or death, while adverse COVID-19 was defined as requirement of COVID-19 related hospitalization. Clinical disease activity was measured by simple clinical colitis index and Harvey-Bradshaw Index in UC and CD, respectively. The biochemical activity was defined as C-reactive protein higher than 5 mg/L or fecal calprotectin higher than 250 μg/g. The endoscopic activity was defined as Mayo Endoscopic Subscore of at least 2 in UC, or Simple Endoscopic Score Crohn’s Disease of at least 3 for CD. Sequelae following COVID-19 were defined as symptoms that (i) developed during or after an infection consistent with COVID-19, (ii) and were present for more than 12 weeks, (iii) and were not attributable to alternative diagnoses.ResultsDuring the inclusion period between January 28th, 2020, to April 1st, 2021, the study included 319 patients with UC and 197 patients with CD who developed laboratory confirmed COVID-19. Of these, data on clinical, biochemical, and endoscopic activity were available among 265/319 (83.1%), 319/319 (100.0%), and 66/319 (20.7%) of patients with UC, respectively, and 140/197 (71.1%), 131/197 (66.5%), and 42/197 (21.3%) of patients with CD. Figures 1–2 outlines the outcomes of COVID-19 according to the degree of clinical, biochemical and endoscopic disease activity. In both UC and CD, clinical, biochemical, and endoscopic activity were not associated with adverse or severe COVID-19, nor long-term outcomes, in unadjusted nor adjusted analysis (Table 1). ConclusionIn this population-based study, we found no association between disease activity of UC or CD and severity of COVID-19. These findings have implications for the risk stratification of patients with IBD acquiring COVID-19.

Background: Endoscopic snare papillectomy (ESP) has been established as a safe and effective treatment for ampullary adenomas. However, little is known about the optimal post-procedure follow-up period and the role of routine endoscopic surveillance biopsy following ESP. We aimed to evaluate patient adherence to a 5-year endoscopic surveillance and routine biopsy protocol after ESP of ampullary adenoma. Methods: We reviewed our prospectively collected database (n = 98), all members of which underwent ESP for ampullary lesions from January 2011 to December 2016, for the evaluation of long-term outcomes. The primary outcome was the rate of patient adherence to 5-year endoscopic surveillance following ESP. The secondary outcomes were the diagnostic yield of routine endoscopic biopsy, recurrence rate, and adverse events after endoscopic surveillance in the 5-year follow-up (3-month, 6-month, and every 1 year). Results: A total of 19 patients (19.4%) experienced recurrence during follow-up, all of these patients experienced recurrence within 3 years of the procedure (median 217 days, range 69–1083). The adherence rate for patients with sporadic ampullary adenoma were 100%, 93.5%, and 33.6% at 1, 3, and 5 years after ESP, respectively. The diagnostic yield of routine endoscopic biopsy without macroscopic abnormality was 0.54%. Pancreatitis occurred in four patients (4%, 3 mild, 1 moderate) after surveillance endoscopic biopsy without macroscopic abnormality. Conclusions: Given the low 5-year adherence rate and diagnostic yield of routine endoscopic biopsy with risk of pancreatitis, optimal surveillance intervals according to risk stratification (low grade vs. high grade adenoma/intramucosal adenocarcinoma) may be required to improve patient adherence, and routine biopsy without macroscopic abnormality may not be recommended.

Objective. To analyze the connection between the complex of platelet indices in complete blood count test with the clinical and endoscopic activity scores for Crohn's disease (CD) and ulcerative colitis (UC) in pediatric patients and to determine their most informative threshold values. Patients and methods. In this study, 370 children aged 5 to 18 years with diagnosed CD (n = 150) and UC (n = 220) were examined. The clinical activity of UC was assessed according to PUCAI, CD – according to PCDAI; the assessment of endoscopic activity in children with UC was carried out according to UCEIS and CD – according to SES-CD. The study included platelet indices of 630 complete blood count tests (270 in patients with CD and 360 in patients with UC): platelet count (PLT), mean platelet volume (MPV), platelet large cell ratio (P-LCR) and platelet distribution width (PDW). Results. Increased platelet count and decreased platelet indices were noted as the clinical and endoscopic activity of CD and UC in children increased. A positive correlation between the clinical and endoscopic activity indices in inflammatory bowel diseases and platelet count and negative correlations with platelet indices were revealed. ROC analysis showed that the informative value of platelet indices in assessing the endoscopic activity of CD and UC is higher than in assessing the clinical activity. The optimal threshold values for platelet count (cut-off) for determining the endoscopic activity of CD and UC were 340 × 109/L and 350 × 109/L (Se 77%, Sp 69% and Se 63%, Sp 67%, respectively). The specificity of determing the endoscopic activity of 99% was obtained for platelet count of 459 × 109/L and 390 × 109/L for CD and UC, respectively. In children with CD, the indicators MPV &lt;7.8 fL, PDW &lt;7.25 fL, P-LCR &lt;15.2% characterized the presence of endoscopic disease activity with 99% specificity; in children with UC, the specificity of determining the endoscopic activity of 99% was obtained for MPV &lt;9.25 fL, PDW &lt;9.85 fL, P-LCR &lt;17.5%. Conclusion. An increase in platelet count and a decrease in platelet indices (MPV, PDW and P-LCR) can be surrogate markers of endoscopic activity of these diseases. The established threshold values will improve the accuracy of diagnosing the activity of inflammatory bowel diseases in children. Key words: Crohn's disease, ulcerative colitis, platelets, platelet indices, clinical activity, endoscopic activity

Despite some variability in ideal serum Adalimumab (ADA) concentrations, there is increasing evidence that higher concentrations of anti-TNF-α agents can be associated with sustained efficacy, and low or undetectable levels may lead to loss of response. This study aims to correlate serum ADA concentrations with clinical and endoscopic activity in patients with Crohn’s disease (CD). A cross-sectional and multicentric study was performed with patients with CD, who used ADA for at least 24 weeks. Patients were allocated into groups according to the presence of clinical or endoscopic disease activity. Serum ADA concentrations were measured and compared between groups. Overall, 89 patients were included. A total of 27 patients had clinically active CD and 62 were in clinical remission. Forty patients had endoscopic disease activity and 49 were in endoscopic remission. The mean serum ADA concentration was 10.2 μg/mL in patients with clinically active CD and 14.3 μg/mL in patients in clinical remission (p = 0.395). The mean serum ADA concentration in patients with endoscopic activity was 11.3 μg/mL as compared to 14.5 μg/mL in those with endoscopic remission (p = 0.566). There was no difference between serum ADA concentrations regarding clinical or endoscopic activity in CD, as compared to patients in remission

BACKGROUND1,3-beta-D-glucan (BG) is a ubiquitous cell wall component of gut micro-organisms. We hypothesized that the serum levels of BG could reflect active intestinal inflammation in patients with inflammatory bowel disease.AIMTo determine whether the serum BG concentrations correlate with intestinal inflammation.METHODSA prospective observational study was performed in a tertiary referral center, from 2016 to 2019, in which serum BG was determined in 115 patients with Crohn’s disease (CD), 51 with ulcerative colitis (UC), and 82 controls using a photometric detection kit. Inflammatory activity was determined by ileocolonoscopy, histopathology, magnetic resonance enterography, and biomarkers, including fecal calprotectin (FC), C-reactive protein, and a panel of cytokines. The ability of BG to detect active vs inactive disease was assessed using the area under the receiver operating characteristic curve. In subgroup analysis, serial BG was used to assess the response to therapeutic interventions.RESULTSThe serum BG levels were higher in CD patients than in controls (P = 0.0001). The BG levels paralleled the endoscopic activity in CD patients and histologic activity and combined endoscopic and histologic activity in both CD and UC patients. The area under the curve (AUC) in receiver operating characteristic analysis to predict endoscopic activity was 0.694 [95% confidence interval (CI): 0.60-0.79; P = 0.001] in CD, and 0.662 (95%CI: 0.51-0.81; P = 0.066) in UC patients. The AUC in receiver operating characteristic analysis to predict histologic activity was 0.860 (95%CI: 0.77-0.95; P < 0.001) in CD, and 0.786 (95%CI: 0.57-0.99; P = 0.015) in UC patients. The cut-off values of BG for both endoscopic and histologic activity were 60 µg/mL in CD, and 40 µg/mL in UC patients. Performance analysis showed that the results based on BG of 40 and 60 µg/mL were more specific for predicting endoscopic activity (71.8% and 87.2% for CD; and 87.5% and 87.5% for UC, respectively) than FC (53.3% and 66.7% for CD; and 20% and 80% for UC, respectively); and also histologic activity (60.5% and 76.3% for CD; and 90.0% and 95.0% for UC, respectively) than FC (41.7% and 50.0% for CD; and 25% and 50% for UC, respectively). Regarding the clinical, endoscopic, and histologic activities, the BG levels were reduced following therapeutic intervention in patients with CD (P < 0.0001) and UC (P = 0.003). Compared with endoscopic (AUC: 0.693; P = 0.002) and histologic (AUC: 0.868; P < 0.001) activity, no significant correlation was found between serum BG and transmural healing based on magnetic resonance enterography (AUC: 0.576; P = 0.192). Positive correlations were detected between BG and IL-17 in the CD (r: 0.737; P = 0.001) and the UC group (r: 0.574; P = 0.005), and between BG and interferon-gamma in the CD group (r: 0.597; P = 0.015).CONCLUSIONSerum BG may represent an important novel noninvasive approach for detecting mucosal inflammation and therapeutically monitoring inflammatory bowel diseases, particularly in CD.

INTRODUCTION: Sacroiliitis (SI), an inflammatory arthropathy of the sacroiliac joints, has an established correlation with Inflammatory Bowel Disease (IBD). Yet SI often goes undiagnosed, and the clinical association between IBD disease activity and SI is not established. Patients with Crohn’s disease (CD) often receive magnetic resonance enterography (MRE), affording clinicians the opportunity to evaluate for the presence of sacroiliitis. We sought to identify the prevalence and disease characteristics associated with SI in CD using MRE. METHODS: All CD patients undergoing MRE for any reason between 2014-2018 at an IBD referral center were identified. A musculoskeletal radiologist reviewed all MRE exams for acute and chronic SI using standardized scoring. We analyzed demographics, IBD characteristics, clinical and endoscopic activity, and management between CD patients with and without SI. RESULTS: 258 patients with CD underwent MRE during the study period. The mean age was 35 years old, 53% were male, and mean duration of CD at MRE was 9 years. Few reported back pain (8%) and 14% had previously seen a rheumatologist. Overall, 17% (n = 45) of patients had MR evidence of SI (Table 1). Female gender, back pain, and later age of CD diagnosis were associated with SI (P = 0.05, P &lt; 0.001; P = 0.04 respectively; Table 2). Disease location and medication exposures were not associated with SI. Stricturing phenotype was associated with a lower rate of SI (7%) compared to inflammatory (48%) or penetrating phenotypes (45%). Disease activity, noted by clinical scores, endoscopic disease activity, or radiographic disease activity, were not associated with SI (Table 2). On multivariable analysis, only back pain was associated with SI (OR 3.01, 95% CI; P = 0.04). CONCLUSION: SI is a common comorbid condition in CD, but often underdiagnosed. With limited clinical clues and disease characteristics to suggest SI, physicians may utilize MRE for clinical activity to assess for SI. Data suggest targeted screening of patients with back pain.

Crohn's disease of the pouch can occur in patients with colectomy and ileal pouch-anal anastomosis performed for ulcerative colitis. The clinical features of inflammatory, fibrostenotic, and fistulizing Crohn's disease have not been characterized. A total of 73 eligible patients with Crohn's disease of the pouch, who were seen in the Pouchitis Clinic, were enrolled: 25 with inflammatory Crohn's disease, 17 with fibrostenotic Crohn's disease, and 31 with fistulizing Crohn's disease. The clinical phenotypes of Crohn's disease were based on a combined assessment of clinical, endoscopic, radiographic, and histologic features. Clinical symptoms, endoscopic and histologic features, and health-related quality-of-life scores were assessed. Demographic and clinical features, including preoperative and postoperative parameters, were similar between the three phenotypes of Crohn's disease of the pouch. The use of nonsteroidal anti-inflammatory drugs, neuropsychiatric drugs, antidiarrheal agents, and Crohn's disease medicines was not different between the three groups. Predominant symptoms, as expected, were significantly different between the three phenotypes: diarrhea and/or pain in 92 percent of patients with inflammatory Crohn's disease, obstructive symptoms in 64.7 percent of patients with fibrostenotic Crohn's disease, and fistular drainage in 51.6 percent of those with fistulizing Crohn's disease (P < 0.0001). There was no statistical difference in quality-of-life scores between the three phenotypes, adjusted for disease activity. There was no significant correlation between quality-of-life and symptom scores in any of the three groups. Although not statistically significant, patients with fistulizing Crohn's disease (16.1 percent) tended to have an increased risk for pouch failure compared with inflammatory (8 percent) or fibrostenotic (5.9 percent) Crohn's disease. Predominant symptoms were different in clinical phenotypes of Crohn's disease. Each of the three phenotypes of Crohn's disease similarly affected quality-of-life. Fistulizing Crohn's disease may be associated with a higher risk for pouch failure.

Background: Sexual and gender minority (SGM) populations are underserved and minoritized. To aid in identifying real world cancer disparities among SGM patients, in 2016 our institution began collecting sexual orientation and gender identity (SOGI) on all patients. Leveraging these valuable data, this study analyzed differences between SGM and non-SGM cancer patients for clinical characteristics and quality-of-life (QoL). Methods: Data were acquired on &amp;gt;118, 000 patients who completed the standard-of-care Electronic Patient Questionnaire which collects self-reported SOGI. Patients were categorized as SGM or non-SGM based on SOGI. Clinical covariates were obtained from cancer registry for a subset of 51, 189 patients. Descriptive statistics and survival analyses were used. Results: ∼3.2% of patients self-identified as SGM. Cancer diagnoses: Breast cancer was the most common diagnosis in SGM and non-SGM patients, followed by melanoma, hematologic, prostate, and lung cancers. Notably, SGM patients exhibited higher-than-expected rates of anorectal (6.8% vs. 0.7%, p&amp;lt;0.001) and uterine cancers (5.4% vs. 3.6%, p&amp;lt;0.001) compared to non-SGM patients. Age: Among the cancers analyzed, the mean age at diagnosis was significantly (p&amp;lt;0.001) lower for SGM compared to non-SGM: breast (54.8 vs. 60.5), melanoma (57.8 vs. 65.5), hematologic (62.0 vs. 67.1), prostate (65.4 vs. 68.1), lung (63.4 vs. 68.9), anorectal (55.1 vs. 64.4), and uterine (55.1 vs. 63.6). Stage: Among anorectal cancers, SGM were more likely to be diagnosed carcinoma in situ compared to non-SGM (45.8% vs. 4.8%, p &amp;lt; 0.001). For uterine cancers, SGM were more frequently diagnosed at stage II compared to non-SGM patients (18.2% vs. 4.8%, p = 0.008). No significant differences were observed for breast, lung, and hematologic cancers. Survival: Cancer site specific analysis revealed no significant differences. QOL: Concerns about barriers to seeking care were significantly higher (p&amp;lt;0.001) among SGM patients with breast (27.0% vs. 15.3%), lung (14.3% vs. 27.2%), and anorectal (35.9% vs. 15.5%) cancers. SGM patients with prostate cancer showed statistically significant lower social support (8.0% vs. 2.9%, p&amp;lt;0.001) and higher rates of living alone (28.4% vs. 10.8%, p&amp;lt;0.001), with similarly higher rates of living alone among SGM patients with anorectal cancer (33.9% vs. 16.3%, p=0.007). Worse mental health was reported by SGM patients with breast, hematologic, melanoma, prostate, uterine cancers (p&amp;lt;0.001), and SGM breast cancer patients had lower physical health scores (47.2% vs. 45.3%, p=0.042). Conclusions: SGM patients were diagnosed at younger age, diagnosed at higher rates of some cancer types, experienced elevated psychosocial challenges, reported worse mental health, and higher barriers to obtaining care. These findings highlight the value of SOGI data in advancing health equity in oncology. Citation Format: Shahrzad A. Zamani, Jaileene Pérez-Morales, Min-Jeong Yang, Matthew B. Schabath. Cancer disparities based on seven years of sexual orientation and gender identity collection at an NCI-Designated Comprehensive Cancer Center [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 4911.

Ulcerative colitis with low-grade dysplasia