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Abstract
The increase risk of cancer development in patients with inflammatory intestinal disease (IBD) has already studied for decades. The anti-TNF therapy has changed the treatment strategy of IBD. By using on a larger scale and for a longer time, the anti-TNF raised concern over its potential adverse events. A male Crohn’s disease (CD) patient, 55 years old, diagnosed for nine years, treated with infliximab for 6 years. In 2011, he underwent a nupper endoscopy (UE) which showed flat erosive gastritis with moderate intensity in antrum, gastric polyps and gastric erosion. Pathological examination revealed a chronic gastritis in erosive activity and search for Helicobacter pylori resulted positive. In May 2014, the patient was asymptomatic, when it held UE, which showed suggestive lesion of early gastric cancer, measuring 1.5 cm and search for Helicobacter pylori negative. Histopathological exams confirmed the adenocarcinoma. The patient underwent to a laparoscopic surgery (total gastrectomy with lymphadenectomy and reconstruction Roux-en-Y). Risk factors for the development of gastric cancer in general population are already well defined. However studying a possible association among CD and the different therapeutic modalities used in the treatment of this disease with gastric cancer appearance is important to set specific assessment strategies, prevention and follow-up. While there is no consensus on a proper monitoring for gastric cancer prevention in these patients, individualized conduct, taking into account individual characteristics, family record and other risk factors, should be adopted to avoid unfavorable outcomes in CD patients.
Highlights
The increase risk of cancer development in patients with inflammatory intestinal disease (IBD) has been studied for decades
The presence of gastric involvement is not established as an unquestionable risk factor for gastric cancer in patients with Crohn’s disease (CD), instead of gastric cancer in these patients which is questioned as an incidental finding in most of them
The presence of family record is an important risk factor for gastric cancer, but when the patient is over 70 years old, this risk becomes questionable
Summary
The increase risk of cancer development in patients with inflammatory intestinal disease (IBD) has been studied for decades. It is known that this group of patients have a higher risk of developing certain cancers if compared with the population in general [1]. It is believed that the presence of genetic and environmental factors may contribute to the increase risk of malignancies in these patients, and some features related to the disease itself. Current evidence suggests that the increase risk of colorectal cancer development seems to be directly related to the extent and activity of the inflammatory disease. The anti-TNF therapy has changed the strategy of treating IBD. These drugs can induce mucosal healing and have been shown as being an effective sparing of steroid use in CD active [2]. We want to discuss how it should be screening and management for patients with CD and gastric cancer
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