Photo Credit: Phonlamai Photo
After a colonoscopy, patients with inactive IBD were more likely to present to the ED, be hospitalized, and be prescribed steroids within 30 days.
At Crohn’s & Colitis Congress 2024, presenters focused on several topics, including medical management of inflammatory bowel disease, gaps in IBD monitoring, and surgical concepts.
A study published in The American Journal of Gastroenterology but not directly related to a presentation at the Congress examined a topic that incorporates a number of these areas. Sidhartha Sinha, MD, and colleagues aimed to determine whether patients with quiescent IBD who undergo colonoscopy for colorectal cancer surveillance experience a higher risk for IBD flare.
In the paper, they wrote, “Patients with IBD have an approximately 3-fold increased risk of colorectal cancer death and undergo frequent surveillance via colonoscopy. Anecdotal evidence and small studies suggest an increased risk of flare after colonoscopy. However, we lack data from large studies.”
The retrospective, self-controlled study included adult men and women with ulcerative colitis or Crohn’s disease. The researchers included only patients who underwent colonoscopy for colorectal cancer screening or surveillance. A composite of ED visit or hospitalization for IBD served as the primary outcome. Rates of steroid prescriptions were measured as a secondary outcome. Both outcomes were assessed by comparing the 30-day period before colonoscopy with the 30-day period after.
Increase in Disease Activity Observed After Colonoscopy
The analysis included 1,982 patients. More than one-half were women (n=1,050) and the median age was 42.6.
Patients with inactive IBD who underwent colonoscopy were more likely to present to the ED or require hospitalization for IBD following the procedure (incident rate ratio [IRR], 2.76; P<0.001). These patients were also more likely to receive a steroid prescription within 30 days of colonoscopy (IRR, 2.01; P<0.001).
“Potential mechanism for this association includes alterations in the gut microbiome and activation of immune pathways by bowel preparation agents,” wrote Dr. Sinha and colleagues in The American Journal of Gastroenterology.
They also wrote that, due to the increased risk for death from colorectal cancer among patients with IBD, “further work should be undertaken to understand if patients who experience active disease after colonoscopy are less likely to complete to future [colorectal cancer] surveillance colonoscopy.”
To read more about findings from Crohn’s and Colitis 2024, including about how patient-reported symptoms influence treatment decisions and outcomes in IBD, click here!
