Background Patients with primary sclerosing cholangitis (PSC) and inflammatory bowel disease (IBD) have an increased risk of developing colorectal neoplasia (CRN) in the proximal colon. Objectives To evaluate whether duration and severity of inflammation are linked to the development of CRN in this population. Design Retrospective, case-control chart review of patients with PSC and IBD at a tertiary care center. Methods Disease activity was scored per colonic segment at each colonoscopy prior to the first instance of observed CRN using a modified Mayo endoscopic sub-score and histologic assessment. Patients in the CRN-positive group were compared to controls that did not. Results In all, 72 PSC-IBD patients with no history of CRN were identified, 13 of whom developed CRN after at least one colonoscopy at our institution. Patients in the CRN-positive group had significantly more endoscopic (p < 0.01) and histologic (p < 0.01) inflammation in the right compared to the control group prior to the development of dysplasia. There was significantly greater endoscopic inflammation in the segment of the colon with a dysplastic lesion than other segments of the colon (p = 0.018). Patients with moderate/severe lifetime endoscopic (p = 0.02) or histologic inflammation (p = 0.04) score had a lower probability of remaining free of dysplasia during follow-up. Nearly half of the patients with dysplasia had invisible lesions found on random biopsy. Conclusions Endoscopic and histologic inflammation in the proximal colon are risk factors for CRN in patients with PSC-IBD. PSC-IBD patients frequently have subclinical inflammation, and these findings support the practice of regular assessment of disease activity and random biopsy of inflamed and uninflamed areas in patients with PSC with the goal of reducing inflammation to prevent the development of CRN.

中文翻译：

---

近端结肠炎症是患有原发性硬化性胆管炎的炎症性肠病患者发生结直肠肿瘤的危险因素。

背景原发性硬化性胆管炎（PSC）和炎症性肠病（IBD）患者近端结肠发生结直肠肿瘤（CRN）的风险增加。目的 评估炎症的持续时间和严重程度是否与该人群中 CRN 的发生有关。设计对三级护理中心的 PSC 和 IBD 患者进行回顾性病例对照图审查。方法 在第一次观察 CRN 之前，使用改良的 Mayo 内窥镜评分和组织学评估，在每次结肠镜检查时对每个结肠段的疾病活动度进行评分。将 CRN 阳性组的患者与非 CRN 阳性的对照组患者进行比较。结果 总共确定了 72 名没有 CRN 病史的 PSC-IBD 患者，其中 13 名患者在我们机构至少进行一次结肠镜检查后出现 CRN。在发育不良发生之前，与对照组相比，CRN 阳性组患者的右侧内镜检查 (p < 0.01) 和组织学 (p < 0.01) 炎症明显增多。具有发育异常病变的结肠段的内镜炎症明显高于结肠的其他段（p = 0.018）。终生内镜检查（p = 0.02）或组织学炎症（p = 0.04）评分为中度/重度的患者在随访期间保持不典型增生的可能性较低。近一半的不典型增生患者在随机活检中发现了看不见的病变。结论 近端结肠的内镜和组织学炎症是 PSC-IBD 患者发生 CRN 的危险因素。PSC-IBD 患者经常出现亚临床炎症，这些发现支持对 PSC 患者的疾病活动性进行定期评估以及对发炎和未发炎区域进行随机活检的做法，目的是减少炎症以预防 CRN 的发展。