Increased risk of colorectal neoplasia in inflammatory bowel disease patients with post-inflammatory polyps:A systematic review and meta-analysis

BACKGROUND Inflammatory bowel disease(IBD)patients with post-inflammatory polyps(PIPs)may carry an increased risk of colorectal neoplasia(CRN)including dysplasia and cancer.Current guidelines recommend active colonoscopy follow-up for these patients.However,the evidence for guidelines is still poor.In addition,some recent high-quality reports present a different view,which challenges the current guidelines.We hypothesize that IBD patients with PIPs are at increased risk of CRN.AIM To evaluate the risk of CRN in IBD patients with and without PIPs.METHODS A systematic search of PubMed,Embase,Cochrane Library,and Web of Science was performed to identify studies that compared the risk of CRN in IBD patients with and without PIPs.In addition,we screened the reference lists and citation indices of the included studies.Quality assessment was performed using the Newcastle–Ottawa Scale.Pooled odds ratio(OR)was calculated using the random-effects model to explore the final pooled effect size of the included studies and determine whether PIPs increase the risk of CRN.Sensitivity analysis,subgroup analysis,and assessment of publication bias were performed to examine the sources of heterogeneity.RESULTS Twelve studies with 5819 IBD patients,including 1281(22.01%)with PIPs,were considered eligible for this meta-analysis.We found that IBD patients with PIPs were at an increased risk of CRN as compared to those without PIPs[OR 2.01;95%confidence interval(CI):1.43–2.83].The results were similar when colorectal cancer was used as the study endpoint(OR 2.57;95%CI:1.69–3.91).Furthermore,the risk of CRN was still increased(OR 1.80;95%CI:1.12–2.91)when restricted to ulcerative colitis patients.Heterogeneity was high among the included studies(I^(2)=75%).Subgroup analysis revealed that the high heterogeneity was due to the study design.Sensitivity analysis showed that the main statistical outcomes did not essentially change after excluding any one of the included studies.No significant publication bias was found in the funnel plots.CONCLUSION IBD patients with PIPs have an increased risk of CRN as compared with those without PIPs,which support the current guidelines.However,a high-quality randomized controlled trial is warranted.

Patients with inflammatory bowel disease and post-inflammatory polyps have an increased risk of colorectal neoplasia:A metaanalysis

BACKGROUND Longstanding intestinal inflammation increases the risk of colorectal neoplasia in patients with inflammatory bowel disease(IBD).Accurately predicting the risk of colorectal neoplasia in the early stage is still challenging.Therefore,identifying visible warning markers of colorectal neoplasia in IBD patients is the focus of the current research.Post-inflammatory polyps(PIPs)are visible markers of severe inflammation under endoscopy.To date,there is controversy regarding the necessity of strengthened surveillance strategies for IBD patients with PIPs.AIM To determine whether IBD patients with PIPs carryan increased risk of colorectal neoplasia.METHODS Researchers searched the following databases up to July 31,2021:MEDLINE(PubMed),MEDLINE(Ovid),EMBASE,Cochrane Library,China National Knowledge Infrastructure,Wan-Fang Data,China Science and Technology Journal Database and Chinese BioMedical Literature Database.Cohort and casecontrol studies that compared the risk of colorectal neoplasia between IBD patients with or without PIPs and published in English or Chinese were included.Methodological quality was assessed using the Risk of Bias in Nonrandomized Studies-of Interventions assessment tool.The outcomes of interest were the rates of various grades of colorectal neoplasia.The pooled risk ratio(RR)and 95%confidence interval(95%CI)were calculated using the random-effects model.Begg’s test and Egger’s test were used to calculate the publication bias.Sensitivity and subgroup analyses were performed to verify the robustness of the results.The Grading of Recommendations,Assessment,Development and Evaluation approach was used to assess the overall quality of evidence supporting the outcomes of interest.RESULTS Nine studies involving 5424 IBD patients(1944 with PIPs vs 3480 without PIPs)were included.The overall bias in each included study ranged from moderate to serious.Compared with nonconcurrent PIPs,patients with PIPs had a higher risk of colorectal neoplasia(RR=1.74,95%CI:1.35-2.24,P<0.001,I2=81.4%;aHR=1.31,95%CI:1.01-1.70,P=0.04,I2=26.2%;aOR=2.62,95%CI:1.77-3.88,P<0.001,I2=0%),advanced colorectal neoplasia(RR=2.07,95%CI:1.49-2.87,P<0.001,I2=77.4%;aHR=1.63,95%CI:1.05-2.53,P=0.03,I2=10.1%)and colorectal cancer(RR=1.93,95%CI:1.32-2.82,P=0.001,I2=83.0%).Publication bias was not observed in Begg’s test or Egger’s test.Sensitivity and subgroup analyses showed that the results are robust.The overall quality of evidence was assessed as moderate to low.CONCLUSION IBD patients with PIPs may have an increased incidence of colorectal neoplasia.

Gene mutations in stool from gastric and colorectal neoplasia patients by next-generation sequencing

AIM To study cancer hotspot mutations by next-generation sequencing(NGS) in stool DNA from patients with different gastrointestinal tract(GIT) neoplasms. METHODS Stool samples were collected from 87 Finnish patients diagnosed with various gastric and colorectal neoplasms, including benign tumors, and from 14 healthy controls. DNA was isolated from stools by usingthe PSP~? Spin Stool DNA Plus Kit. For each sample, 20 ng of DNA was used to construct sequencing libraries using the Ion AmpliS eq Cancer Hotspot Panel v2 or Ion AmpliS eq Colon and Lung Cancer panel v2. Sequencing was performed on Ion PGM. Torrent Suite Software v.5.2.2 was used for variant calling and data analysis.RESULTS NGS was successful in assaying 72 GIT samples and 13 healthy controls, with success rates of the assay being78% for stomach neoplasia and 87% for colorectal tumors. In stool specimens from patients with gastric neoplasia, five hotspot mutations were found in APC,CDKN2 A and EGFR genes, in addition to seven novel mutations. From colorectal patients, 20 mutations were detected in AKT1, APC, ERBB2, FBXW7, KIT, KRAS,NRAS, SMARCB1, SMO, STK11 and TP53. Healthy controls did not exhibit any hotspot mutations, except for two novel ones. APC and TP53 were the most frequently mutated genes in colorectal neoplasms, with five mutations, followed by KRAS with two mutations.APC was the most commonly mutated gene in stools of patients with premalignant/benign GIT lesions.CONCLUSION Our results show that in addition to colorectal neoplasms,mutations can also be assayed from stool specimens of patients with gastric neoplasms.

Care Technologies in Nursing for People with Colorectal Neoplasia: Integrative Review

Objective: Identifying in the literature the care technologies used by nurses for people with colorectal neoplasia on Nietzsche’s conceptual perspective. Method: It consists in an integrative review of the literature held in the database: Latin-American Literature and Caribbean in medical health sciences Literature Analysis and Retrieval System Online, Database in Nursing, US National Library of Medicine, Cumulative Index to Nursing & Allied Health Literature, Scopus Info Site and Web of Science in December 2015. Results: 28 articles were selected to compose the final sample of this review, which were analyzed and categorized in management technology (86.20%), assistance technology (20.68%) and educational technology (10.34%). Studies published in the last five years have predominated (62.06%), in international territory (82.75%) and with evidence level IV (44.82%). Conclusion: Today the growth on the production about this theme has been highlighted, but there is an important discrepancy between the researches with high and low level of scientific evidence, showing the need of more studies about technologies that strengthen the experience of nursing.

Emerging use of artificial intelligence in inflammatory bowel disease

Inflammatory bowel disease(IBD)is a complex,immune-mediated gastrointestinal disorder with ill-defined etiology,multifaceted diagnostic criteria,and unpredictable treatment response.Innovations in IBD diagnostics,including developments in genomic sequencing and molecular analytics,have generated tremendous interest in leveraging these large data platforms into clinically meaningful tools.Artificial intelligence,through machine learning facilitates the interpretation of large arrays of data,and may provide insight to improving IBD outcomes.While potential applications of machine learning models are vast,further research is needed to generate standardized models that can be adapted to target IBD populations.

炎症性肠病患者结直肠瘤变的危险因素:一项多中心研究

背景:本研究旨在评估中国炎症性肠病(IBD)患者肠炎相关瘤变(CAN)发生的危险因素。方法:从8家医学中心收集1999-2016年间发生CAN的IBD患者。除了最初的病理评估,CAN的诊断尚需两位病理专家确认。最终筛选出29例CAN患者,并基于性别和IBD类型按1:3进行匹配,获得87例非CAN对照病例。结果:29例CAN患者中,8例(27.6%)为结直肠癌,20例(69.0%)诊断为低级别上皮内瘤变,1例(3.4%)诊断为高级别上皮内瘤变。多因素分析显示,IBD诊断年龄和IBD病程是出现CAN的独立危险因素,其OR值分别为1.09(95%CI:1.04-1.14,P<0.001)和1.14(95%CI:1.03-1.27,P=0.013)。进一步对结直肠癌与上皮内瘤变患者进行比较,结果显示,前者IBD诊断年龄更大(P=0.012),IBD病程更长(P=0.019)。结论:IBD诊断年龄更大、IBD病程更长者,发生CAN的概率增加。