Colorectal Cancer In Ulcerative Colitis Research Articles

Exploring the mechanism and key active components of Gegen Qinlian decoction combined with XELOX in the treatment of ulcerative colitis-associated colorectal cancer based on network pharmacology and multi-omics analysis

Ulcerative colitis (UC) is an autoimmune disease with a steady increase in global prevalence and long-term susceptibility to colorectal cancer (CRC). CRC is often treated with XELOX regimen (oxaliplatin and capecitabine), which is limited by the high toxicity, many adverse reactions and intolerance of patients, thus often leading to termination of chemotherapy. Traditional Chinese medicine is effective in improving patients' clinical symptoms. Gegen Qinlian decoction (GQD) is frequently utilized in the management of UC and has the potential to treat CRC. Whereas, there are few studies on GQD in the treatment of UC-associated CRC, and the therapeutic mechanism of GQD combined with XELOX has not been fully reported. Herein, HPLC-Q-TOF-MS/MS technique was used to analyze the main chemical components of GQD. Network pharmacology was performed to unveil the critical genes and components of GQD against UC and UC-associated CRC. The detection of TNF-α, IL-1β, IL-6, VEGF, SOD, MDA and immune factors revealed that GQD played a key role in improving immune function, reducing inflammation and resisting oxidative stress. 16S rDNA sequencing technology results showed that GQD could maintain gastrointestinal homeostasis by increasing beneficial bacteria and decreasing harmful bacteria. Then, metabolomics based on HPLC-Q-TOF-MS/MS found that the combination of GQD and XELOX could significantly restore the disturbance of metabolites. Particularly, the compound-reaction-gene-enzyme network was first constructed to realize the combination of network pharmacology and metabolomics. The results showed that GQD may assist XELOX to play a synergistic anti-tumor role by regulating the key enzymes ALOX15, CYP1B1 and PTGS2 in unsaturated fatty acid metabolism. Finally, the mechanism was verified by western blot, and the key pharmacodynamic components were found by molecular docking. Overall, the current study offered fresh perspectives on both the prevention and treatment of UC to CRC as well as fresh concepts for the therapeutic application of GQD with XELOX to lessen the side effects of chemotherapy and enhance patients' quality of life.

Multifocal Colorectal Cancer in Ulcerative Colitis Patient - Case Report

Ulcerative colitis (CU) is an inflammatory disease predisposing to colorectal cancer. Colorectal cancer in ulcerative colitis is more often metachronous or synchronous. In this case report we present a patient with multifocal colorectal cancer in the course of CU and operative treatment that was implemented. Additionally primary sclerosing cholangitis was diagnosed in this patient post-operatively.

Stable Incidence and Risk Factors of Colorectal Cancer in Ulcerative Colitis: A Population-Based Cohort Between 1977–2020

Stable Incidence and Risk Factors of Colorectal Cancer in Ulcerative Colitis: A Population-Based Cohort Between 1977–2020

Colorectal cancer in ulcerative colitis (review)

Ulcerative colitis (UC) is an inflammatory bowel disease that mainly affects young people. Colorectal cancer (CRC) is one of the UC complications. This review considers the epidemiology, risk factors, diagnosis and screening, and drug prevention of CRC in UC. Various treatment options for dysplasia and CRC associated with UC are described. Taking into account the lack of literature to standardize colorectal cancer treatment approaches (especially rectal cancer) for UC, further studies are warranted to evaluate both oncological and functional treatment outcomes.

Novel biomarkers for neoplastic progression from ulcerative colitis to colorectal cancer: a systems biology approach

In recent studies, the void of evaluation and in-depth understanding of unknown clinically relevant potential molecular biomarkers involved in colorectal cancer (CRC) from the inflammatory stage of ulcerative colitis (UC) to CRC metastasis, which can be suitable therapeutic targets, is deeply felt. The regulation and interaction among different cancer-promoting molecules, including messenger RNAs (mRNAs) and micro RNAs (miRNAs) in CRC and its progression, were the aim we pursued in this study. Using microarray data, we investigated the differential expression for five datasets, including mRNA and microRNA samples related to UC, tumor/normal. Then, using robust data analysis, separate lists of differentially expressed genes (DEGs) and differentially expressed miRNAs (DEmiRNAs) were identified, which were used for robust rank aggregation (RRA) and co-expression network analysis. Then, comprehensive computational systems biology analyses, including gene ontology and Kyoto encyclopedia of genes and genomic pathway enrichment analyses, mRNA-miRNA regulatory network, and survival analysis, were employed to achieve the aim of this study. Finally, we used clinical samples to validate this potential and new target. According to this systems biology approach, a total of 98 DEGs and 8 DEmiRNAs with common differential expression were identified. By combining the distinct results of RRA and network, several potential therapeutic targets, and predictive and prognostic biomarkers for UC and CRC were identified. These targets include six common hub genes, CXCL1, CXCL8, MMP7, SLCA16A9, PLAU, and TIMP1, which are upregulated. Among these, the important and new biomarker SLC16A9 is negatively regulated by hsa-mir-194-5p, and hsa-miR-378a-5p take. The findings of the present study provide new insight into the pathogenesis of CRC in UC. Our study suggests future evaluation of the functional role of SLC16A9 and hsa-mir-194-5p and hsa-miR-378a-5p in CRC development.

[Risk factors and chemoprophylaxis of ulcerative colitis-colorectal cancer].

Ulcerative colitis-colorectal cancer (UC-CRC) is one of the most serious complications in patients with ulcerative colitis (UC), with worse prognosis and higher mortality than sporadic colorectal cancer (CRC). Since most UC-CRC developed through the "inflammation-dysplasia-carcinoma" approach, early detection of dysplasia through identification of high-risk groups reasonable monitoring and active prevention are extremely important. However, there is no consensus on the risk factors of UC carcinogenesis and the drugs that can be used for chemoprevention currently. This article combined with relevant literature at home and abroad, reviewed the current risk factors and chemopreventive drugs for UC carcinogenesis, in order to provide reference for early prevention, early detection and early diagnosis of UC-CRC.

Colorectal Cancer in Ulcerative Colitis: Mechanisms, Surveillance and Chemoprevention.

Patients with ulcerative colitis (UC) are at a two- to three-fold increased risk of developing colorectal cancer (CRC) than the general population based on population-based data. UC-CRC has generated a series of clinical problems, which are reflected in its worse prognosis and higher mortality than sporadic CRC. Chronic inflammation is a significant contributor to the development of UC-CRC, so comprehending the relationship between the proinflammatory factors and epithelial cells together with downstream signaling pathways is the core to elucidate the mechanisms involved in developing of CRC. Clinical studies have shown the importance of early prevention, detection and management of CRC in patients with UC, and colonoscopic surveillance at regular intervals with multiple biopsies is considered the most effective way. The use of endoscopy with targeted biopsies of visible lesions has been supported in most populations. In contrast, random biopsies in patients with high-risk characteristics have been suggested during surveillance. Some of the agents used to treat UC are chemopreventive, the effects of which will be examined in cancers in UC in a population-based setting. In this review, we outline the current state of potential risk factors and chemopreventive recommendations in UC-CRC, with a specific focus on the proinflammatory mechanisms in promoting CRC and evidence for personalized surveillance.

Risk Factors for Colorectal Cancer in Inpatients With Ulcerative Colitis: A Nationwide Cross-Sectional Analysis.

ObjectivesThe objective is to study the demographic and geographical factors that increase the risk of colorectal cancer (CRC) in inpatients with ulcerative colitis (UC) and evaluate the mortality risk and hospitalization outcomes in terms of length of stay (LOS) and cost of care in patients with CRC in UC.MethodsWe conducted a cross-sectional study using the nationwide inpatient sample (NIS, 2019). We included 78,835 inpatients (age 15-65 years) hospitalized on emergency-based admissions with a primary diagnosis of UC. The study sample was divided by the presence of CRC. Categorical and continuous data were analyzed using Pearson’s chi-square test and independent-sample t-test respectively. Independent binomial logistic regression models were used to evaluate the odds ratio (OR) of predictors associated with CRC in patients with UC compared to non-CRC.ResultsThe prevalence of CRC in inpatients with UC was 0.2%, and the mean age for admission of patients with UC with CRC was 49.6 years (SD ± 10.29). A directly proportionate relationship exists between increasing age and the risk of CRC in UC inpatients with 10 times higher odds seen in 51-65 years of age (OR 10.0, 95% CI 5.11-19.61). Males (OR 2.15, 95% CI 1.49-3.08) and Hispanics (OR 1.69, 95% CI 1.04-2.74) are at higher odds for CRC compared to their counterparts. Acquired immunodeficiency syndrome (AIDS) was associated with increased odds (OR 6.23, 95% CI 2.48-15.68) for CRC in UC inpatients. There existed an increased association for CRC in UC inpatients with complicated hypertension, and alcohol and drug abuse but was statistically non-significant. As per the adjusted regression model, CRC in UC inpatients increased the risk of in-hospital mortality (OR 41.09, 95% CI 19.49-86.58).ConclusionsCRC was more prevalent in middle-aged Caucasian males with UC and those with chronic comorbidities including complicated diabetes and hypertension, alcohol abuse, and AIDS. Patients with UC and AIDS were found to have greater odds of developing CRC. A high index of clinical suspicion is needed in the management of these patient groups as the inpatient mortality risk was higher in UC inpatients with CRC.

Periodic Colonoscopies Are Associated with Improved Survival and Prognosis of Colorectal Cancer in Ulcerative Colitis.

This study aimed to identify whether ulcerative colitis (UC) patients who develop colorectal cancer (CRC) present at earlier stages of CRC and have improved survival if prior to their CRC diagnosis, they underwent intermittent follow-up colonoscopies compared to those who have no follow-up colonoscopies. Patients with UC who developed primary CRC were identified using data provided by the Institute for Clinical Evaluative Sciences. We defined low-risk CRC stage as estimated 5-year survival ≥ 80% compared to high-risk CRC as 5-year survival < 80%. A total of 421 patients were identified with UC and CRC. The 15-year mortality rate was significantly higher in those who did not have follow-up colonoscopy (33/74; 44.6%) compared to the follow-up group (105/347; 30.3%) (p = 0.0172). Among the 219 patients with UC with staging information available, patients who did not have follow-up colonoscopy were more likely to present with high-risk CRC (24/31; 77.4%) compared with patients who had follow-up colonoscopies (88/188; 44.4%) (p = 0.0016). Those who underwent follow-up colonoscopies at average intervals ≤ 3years presented with high-risk CRC 41.3% of the time, which was less than the 48.6% in those with less frequent colonoscopies and 77.4% in those with no follow-up (p = 0.0048). Patients with UC who underwent intermittent follow-up colonoscopies had CRC detected at earlier stages and improvement in all-cause mortality, compared to those who with no follow-up colonoscopies. This may support regular surveillance colonoscopies for patients with UC.

A case-control study examining the association of smad7 and TLR single nucleotide polymorphisms on the risk of colorectal cancer in ulcerative colitis.

Ulcerative colitis (UC) is characterized by chronic mucosal inflammation and an increased risk of colorectal cancer. smad7, TLR2 and TLR4 modulate intestinal inflammation and their polymorphisms affect the risk of development of sporadic colorectal cancer. The aim of the current study was to examine the association between single nucleotide polymorphisms (SNPs) in smad7, TLR2 and TLR4 and the development of colorectal cancer in patients with UC. DNA was extracted from formalin-fixed, paraffin-embedded tissue from 90 patients with UC who had undergone panproctocolectomy between 1985 and 2013 (30 with UC-associated colorectal cancer and 60 control UC patients). Control cases were matched 2:1 for age at diagnosis of colitis, duration of disease and gender. Genotyping was performed for the smad7 rs4464148, rs11874392, rs12953717 and rs4939827 SNPs, the TLR2 rs5743704 and rs5743708 SNPs and the TLR4 rs4986790 and rs4986791 SNPs. Sixty three of the 90 patients (70%) were men and the mean age at diagnosis of UC was 38.6±1.6years. The mean time to the diagnosis of UC-associated colorectal cancer was 13.5±1.9years. The 5-year recurrence-free and cancer-specific survival rates were 76% and 88%, respectively. All eight SNPs were in Hardy-Weinberg equilibrium. None of the eight SNPs assessed in smad7, TLR2 or TLR4 were associated with the development of UC-associated colorectal cancer at an allelic or genotypic level. These data do not support an association between polymorphisms in smad7, TLR2 or TLR4 and the development of UC-associated colorectal cancer.

S1574 Colorectal Cancer in a Young Male With Primary Sclerosing Cholangitis Without Underlying Inflammatory Bowel Disease

INTRODUCTION: Primary Sclerosing Cholangitis (PSC) presents with hepatic duct inflammation, fibrosis and stricturing leading to biliary obstruction, recurrent cholangitis and eventually end-stage liver disease. There is a strong association between PSC and Inflammatory Bowel Disease (IBD), especially Ulcerative Colitis (UC), which itself is strongly associated with Colorectal Cancer (CRC) development. Thus, all patients diagnosed with PSC must undergo a colonoscopy to evaluate for concomitant IBD even if asymptomatic at the time of diagnosis. The cumulative absolute risk of CRC or dysplasia in patients with both PSC and UC is approximately 5 to 6 times higher than CRC in UC alone. The classic presentation of PSC is marked by abnormal liver enzymes or cholestatic symptoms. Subsequent colonoscopy identifies underlying IBD in up to 80% of cases which often progresses to CRC. We describe the case of a healthy 29-year-old male newly diagnosed with PSC. Colonoscopy revealed an extremely rare presentation of adenocarcinoma without apparent underlying IBD. CASE DESCRIPTION/METHODS: 29-year-old active-duty male presented with 6 days of nausea, vomiting, scleral icterus and abdominal discomfort. Initial total bilirubin was 11.7 mg/dL with transaminitis, elevated alkaline phosphatase and CA 19-9. IBD panel and infectious workup were negative. RUQUS and abdominal CT revealed segmental dilatation of common bile duct and mural thickening of the sigmoid colon. Follow-up MRCP / ERCP showed severely stenotic main bile duct limiting further evaluation (Figure 1). Colonoscopy found a hemicircumferential, ulcerated, friable 4 cm × 3 cm mass in the sigmoid colon, with otherwise normal colonic mucosa (Figure 2). Histologic examination demonstrated invasive poorly differentiated adenocarcinoma. His bilirubin continued to rise to 19.4 mg/dL and required biliary drain placement. Subsequent CT chest showed multiple scattered, solid nodules and the patient was transferred for further staging and potential liver transplant. DISCUSSION: This case is notable as our patient’s PSC diagnosis was immediately followed by the discovery of colon adenocarcinoma without underlying IBD. Though IBD in patients with PSC tends to be asymptomatic at the time of diagnosis, the endoscopic and histologic appearance of the colon is nearly always consistent with underlying IBD. This case exemplifies that PSC may be a direct risk factor for the development of CRC even in the absence of underlying IBD.Figure 1.: ERCP with limited contrast transmission (arrow) due to the severely stenosed main bile duct.Figure 2.: Fungating Sigmoid Colon lesion prior to biopsy.

S0774 Risk Factors for Colorectal Cancer in Inflammatory Bowel Disease: Observations From a Single Center

INTRODUCTION: Inflammatory bowel disease (IBD) imparts a significant risk of colorectal cancer (CRC). Inflammation mediated genetic instability, oxidative stress, altered immune response from inflammatory mediators and effect of intestinal microbiota have been proposed for increased risk of CRC in this population. Publications on factors associated with increased risk of CRC on IBD patients is scarce. The objective of this study was to identify the risk factors associated with CRC in patients with Crohn's disease (CD) and Ulcerative colitis (UC). METHODS: A retrospective study design was used to collect data on baseline demographics, comorbidities, and outcomes in patients with the diagnosis of UC and CD from a single center. Multiple comorbid conditions and use of medications; statins and NSAIDS were reviewed. Multi-variate logistic regression analysis was performed to identify risk factors associated with the diagnosis of colorectal cancer in this patient population. RESULTS: Study sample consisted of 2978 patients; of these 1595 had UC whereas the rest had CD. Mean age for the UC cohort was 57.7 ± 17.6, mean BMI was 28.9 ± 6.8, 54.7% were female. Mean age for CD cohort was 53.0 ± 7.3, mean BMI was 28.3 ± 7.6, 58.2% were female. CRC was diagnosed in 22 patients in CD cohort whereas in the UC cohort, 18 patients were diagnosed with CRC (P = .51). Hypertension, cirrhosis and >10 flares were associated with the diagnosis of CRC in CD (Table 1). Increasing age, female gender, diabetes mellitus and osteoporosis were associated with CRC in UC (Table 2). The predictive capacity of logistic regression models as obtained by receiver operating curves in outlined in Figure 1. CONCLUSION: Patients with IBD have increased risk of CRC than normal population and it is an important cause of mortality in IBD patients. This observational analysis identified varying epidemiologic factors associated with CRC. Interestingly, disease activity as measures by surrogacy of >10 flares was associated with CRC diagnosis in CD cohort but not so in UC cohort. Previous meta-analyses have shown protective effect of statins in UC and CD, which was not seen in our study. Use of NSAIDS was not associated with increased or decreased risk of CRC.Table 1.: Risk factors for CRC in CDTable 2.: Risk factors for CRC in UCFigure 1.: ROC.

A nationwide database study on colectomy and colorectal cancer in ulcerative colitis: what is the role of appendectomy?

Although has been suggested that an appendectomy has a positive effect on the disease course in patients with ulcerative colitis (UC), recent studies indicate a potential increase in risk of colectomy and colorectal cancer (CRC). This study aimed to evaluate the rates of colectomy and CRC after appendectomy in UC patients using a nationwide prospective database [the Initiative on Crohn and Colitis Parelsnoer Institute - Inflammatory Bowel Disease (ICC PSI-IBD) database]. All UC patients were retrieved from the ICC PSI-IBD database between January 2007 and May 2018. Primary outcomes were colectomy and CRC. Outcomes were compared in patients with and without appendectomy, with a separate analysis for timing of appendectomy (before or after UC diagnosis). A total of 826 UC patients (54.7% female; median age 46years, range 18-89 years) were included. Sixty-three (7.6%) patients had previously undergone appendectomy: 24 (38.1%) before and 33 (52.4%) after their diagnosis of UC. In multivariate analysis, appendectomy after UC diagnosis was associated with a significantly lower colectomy rate compared with no appendectomy [hazard ratio (HR) 0.16, 95% C: 0.04-0.66, P=0.011], and the same nonsignificant trend was seen in patients with an appendectomy before UC diagnosis (HR 0.35, 95% CI 0.08-1.41, P=0.138). Appendectomy was associated with delayed colectomy, particularly when it was performed after diagnosis of UC (P=0.009). No significant differences were found in the CRC rate between patients with and without appendectomy (1.6% vs 1.2%; P=0.555). Appendectomy in established UC is associated with an 84% decreased risk of colectomy and a delay in surgery. Since the colon is in situ for longer, the risk of developing CRC remains, which underscores the importance of endoscopic surveillance programmes.

Risk of colorectal cancer in a population-based study 20 years after diagnosis of ulcerative colitis: results from the IBSEN study

ObjectiveThe association between ulcerative colitis (UC) and colorectal cancer (CRC) is widely accepted, although attenuated risk has been reported in recent years. Colonoscopic surveillance is recommended with intervals based on...

Long-term incidence of dysplasia and colorectal cancer in an ulcerative colitis population-based cohort.

Ulcerative colitis (UC) is a risk factor in developing colorectal cancer (CRC). Surveillance programmes aim to identify premalignant lesions to facilitate improved treatment outcomes. Recent studies have suggested that the risk of CRC in UC has decreased. This study aims to characterize the risk of CRC in UC in a population-based New Zealand cohort. All patients in the Canterbury Inflammatory Bowel Disease Study, a comprehensive population-based cohort, were reviewed and cases of dysplasia and CRC identified. Demographic data and risk factors were assessed and standardized incidence ratios (SIRs) calculated comparing with the national population. A total of 518 UC cases were analysed (46.3% female). Median follow-up was 17.5 years (interquartile range 12.2-25.1 years). Neoplasia developed in 42 (8.1%) patients, 14 (2.7%) of whom had CRC. The mean age at CRC diagnosis was 63.3 years, and mean duration with UC before CRC 18.4 years (0-36.8 years). The total incidence rate was 1.35/1000 person-year duration (95% confidence interval 0.74-2.27). The age-adjusted SIR was 1.74 (95% confidence interval 1.03-2.93) compared to the New Zealand population. Risk factors for any dysplasia included disease extent and male gender. In this population-based cohort with long-term follow-up, the SIR of CRC in UC patients was significantly lower than the initial epidemiological studies although similar to more recent studies. This increased risk still justifies ongoing screening in the UC population.

[Colitis-associated colorectal cancer in ulcerative colitis - current status and problems of surgical treatment].

[Colitis-associated colorectal cancer in ulcerative colitis - current status and problems of surgical treatment].

Colorectal cancer in ulcerative colitis: a Scandinavian population-based cohort study

Ulcerative colitis (UC) is a risk factor for colorectal cancer (CRC). However, available studies reflect older treatment and surveillance paradigms, and most have assessed risks for incident CRC without taking surveillance and lead-time bias into account, such as by assessing CRC incidence by tumour stage, or stage-adjusted mortality from CRC. We aimed to compare both overall and country-specific risks of CRC mortality and incident CRC among patients with UC. In this population-based cohort study of 96 447 patients with UC in Denmark (n=32 919) and Sweden (n=63 528), patients were followed up for CRC incidence and CRC mortality between Jan 1, 1969, and Dec 31, 2017, and compared with matched reference individuals from the general population (n=949 207). Patients with UC were selected from national registers and included in the analysis if they had two or more records with a relevant International Classification of Disease in the patient register (in the country in question) or one such record plus a colorectal biopsy report with a morphology code suggestive of inflammatory bowel disease. For every patient with UC, we selected matched reference individuals from the total population registers of Denmark and Sweden, who were matched for sex, age, birth year, and place of residence. We used Cox regression to compute hazard ratios (HRs) for incident CRC, and for CRC mortality, taking tumour stage into account. During follow-up, we observed 1336 incident CRCs in the UC cohort (1·29 per 1000 person-years) and 9544 incident CRCs in reference individuals (0·82 per 1000 person-years; HR 1·66, 95% CI 1·57-1·76). In the UC cohort, 639 patients died from CRC (0·55 per 1000 person-years), compared with 4451 reference individuals (0·38 per 1000 person-years; HR 1·59, 95% CI 1·46-1·72) during the same time period. The CRC stage distribution in people with UC was less advanced (p<0·0001) than in matched reference individuals, but taking tumour stage into account, patients with UC and CRC remained at increased risk of CRC death (HR 1·54, 95% CI 1·33-1·78). The excess risks declined over calendar periods: during the last 5 years of follow-up (2013-17, Sweden only), the HR for incident CRC in people with UC was 1·38 (95% CI 1·20-1·60, or one additional case per 1058 patients with UC per 5 years) and the HR for death from CRC was 1·25 (95% CI 1·03-1·51, or one additional case per 3041 patients with UC per 5 years). Compared with those without UC, individuals with UC are at increased risk of developing CRC, are diagnosed with less advanced CRC, and are at increased risk of dying from CRC, although these excess risks have declined substantially over time. There still seems to be room for improvement in international surveillance guidelines. The Swedish Medical Society, Karolinska Institutet, Stockholm County Council, Swedish Research Council, Swedish Foundation for Strategic Research, Independent Research Fund Denmark, Forte Foundation, Swedish Cancer Foundation.

A unique polysaccharide from Hericium erinaceus mycelium ameliorates acetic acid-induced ulcerative colitis rats by modulating the composition of the gut microbiota, short chain fatty acids levels and GPR41/43 respectors

Ulcerative colitis (UC) is an idiopathic, chronic inflammatory disorder of the colonic mucosa. Risk of colorectal cancer in ulcerative colitis is increased in patients with long-standing disease compared with the general population. Hericium erinaceus (HE) has been used in traditional folk medicine and medicinal cuisine in China, Korea and Japan with anti-gastritis and anti-ulcerative colitis activities. EP-1, a purified unique polysaccharide isolated from HE mycelium, has recently been identified as the active component responsible for anti- ulcerative colitis activity by using a cell model for identification. In this study, our data shows that EP-1 was effective in relieving the symptoms of acetic acid induced UC rats. Based on the Illumina MiSeq platform, 16S rRNA sequencing of the rat colonic contents indicated that the intestinal flora structure remarkably changed in the model rats and the tendency was alleviated to a certain degree by EP-1. The further results showed that in the acetic acid induced UC rats EP-1 modulated the gut microbiota community and increased short chain fatty acids (SCFAs). And immunoblot analyses showed that after treated by EP-1, GPR41 and GPR43 were significantly suppressed expression in colonic tissues of the UC rats. In the meanwhile, EP-1 also showed its antioxidant, anti-inflammatory and enhancing immune activities. Thus, the polysaccharide purified from HE showed potential for anti-UC activity and the complementary and alternative medicine (CAM) herb therapy.

934 – A National Database Study on Colectomy and Colorectal Cancer in Ulcerative Colitis: What is the Role of Appendectomy?

934 – A National Database Study on Colectomy and Colorectal Cancer in Ulcerative Colitis: What is the Role of Appendectomy?

P593 A national database study on colectomy and colorectal cancer in ulcerative colitis: what is the role of appendectomy?

Appendectomy prevents the development of ulcerative colitis (UC), and might have a positive effect on the disease course of UC. However, several studies indicated an increased risk of colectomy and colorectal cancer (CRC) after appendectomy in UC, and discourage the use of an experimental appendectomy. Nonetheless, it seems premature to draw strong conclusions, as these retrospective studies did not correct for possible confounding factors. The aim of this study was to evaluate the risk of colectomy and CRC after appendectomy in UC patients, while correcting for relevant confounders. All included patients were retrieved from the prospective national Initiative on Crohns and Colitis Parelsnoer Institute – inflammatory bowel disease (IBD) database. From 2007, consecutive IBD patients were continuously invited to participate. For inclusion in the current study, patients had to have UC, and data on both appendectomy and colectomy and/or CRC rate had to be available. Primary outcomes were the risk of colectomy and CRC. Outcomes were compared in patients with and without appendectomy, with a separate analysis for timing of appendectomy (before or after UC diagnosis). In total, 826 UC patients (54.7% female) with a median age of 46 (range 18–89) years were included from 2007 until May 2018. Sixty-three (7.6%) patients previously had an appendectomy: 24 (38.1%) before UC diagnosis, 33 (52.3%) after diagnosis, and in 6 (9.5%) patients the timing was unknown. On baseline characteristics, patients with an appendectomy had a significantly lower rate of colectomy (19.0% vs. 37.6%; p = 0.003) and tended to have more often PSC (11.8% vs. 5.7%; p = 0.090). In multi-variate analysis, appendectomy after UC diagnosis was associated with a significantly lower risk of colectomy compared with no appendectomy (HR 0.15, 95% CI 0.04–0.59; p = 0.007), and the same trend was seen in patients with appendectomy before UC (HR 0.36, 95% CI 0.09–1.47; p = 0.156). Kaplan–Meier analysis demonstrated that appendectomy was associated with a significantly postponed colectomy, in particular when performed after UC diagnosis (p = 0.009). No significant differences were found in the CRC rate for patients with and without an appendectomy (1.6% vs. 1.2%; p = 0.555). An appendectomy during the course of UC is associated with an 85% decreased risk of colectomy and a postponed resection in patients who did undergo colectomy. As the colon is longer in situ the risk of developing CRC remains, emphasising the importance of endoscopic surveillance.