P-103 Type of Inflammatory Bowel Disease Does Not Influence Rate of Cervical Dysplasia

Abstract

Women with inflammatory bowel disease (IBD) have been reported to have an increased risk for cervical dysplasia compared to the general population. Several studies have revealed more than a 4-fold increase in abnormal Pap smears in IBD women. Human papilloma virus (HPV) and medication-induced immunosuppression have been cited to be significant factors related to Pap smear irregularity. It is unclear if the type of IBD influences the development of cervical dysplasia. This study evaluated the rate of cervical dysplasia in women with Crohn’s disease and ulcerative colitis. A retrospective medical records review of women cared for at a university IBD center during a 1.5 year period was conducted. There were no exclusion factors. Patient age, gender, disease type, medication regimen and Pap smear results were obtained. Pap smears were considered abnormal if there were HPV-associated changes or cervical dysplasia. A database was created using Microsoft Excel. Statistical significance was performed using Fischer Exact test, with significance set at P < 0.05. The study was approved by the university Institutional Review Board. Two hundred eight medical records of IBD women (mean age 43 years) were reviewed. One hundred eleven (53.4%) women had Crohn’s disease, 95 (45.7%) had ulcerative colitis and 2 (1.0%) had indeterminate colitis. One hundred seven (51.4%) women had Pap smears performed. Fifty-five of 111 (49.5%) women with Crohn’s disease, 51 of 95 (53.7%) women with ulcerative colitis and 1 of 2 (50%) women with indeterminate colitis had Pap smears. There was no significant difference (P = 0.578) in the rate of Pap smear performance based upon disease type. Sixteen of 55 (29.1%) women with Crohn’s disease and 14 of 51 (27.5%) women with ulcerative colitis had HPV positivity, HPV-associated changes or cervical dysplasia on Pap smear. There was no significant difference (P = 1.000) in the rate of abnormal Pap smears based upon disease type. Women with inflammatory bowel disease have an increased rate of abnormal Pap smears when compared to the general population. Studies have reported that the cervical abnormalities are likely related to HPV-induced changes. While HPV and immunosuppression from medications may be significant risk factors for the development of cervical dysplasia, it is uncertain if there are other contributing factors to the increase rate of irregular Pap smears in women with inflammatory bowel disease. This study revealed that women with IBD infrequently underwent recommended cervical cancer screening. There was no difference in the rate of screening between women with Crohn’s disease and ulcerative colitis. In addition, there was no difference in the frequency of abnormal Pap smears between women with Crohn’s disease and ulcerative colitis. Further research needs to be conducted to determine all of the factors that may have a significant role in cervical dysplasia in women with inflammatory bowel disease.