SAGES Magazine

THE SOUTH AFRICAN GASTROENTEROLOGY REVIEW 2023 | VOLUME 21 | ISSUE 1 | 9 Chemoprevention Optimal disease control of inflammation with medical therapy is the main strategy to reduce the lifetime risk of CRC in patients with IBD. Notwithstanding, there is some evidence that the early use of 5-aminosaliscylates (5-ASAs) independently reduce the risk of progression to CRC by 49% 26 . Based on this data, ECCO recommends that for patients with UC extending beyond the rectum, 5-ASAs can be used as chemoprevention 27 . No specific recommendation is made for CD colitis. ECCO further recommends against the use of thiopurines or any other agents including biologics, small molecules) as chemoprevention, as there is insufficient data. Many other medications including ursodeoxycholic acid, non-steroidal anti-inflammatory drugs (NSAIDs), statins, folic acid, and calcium/vitamin D supplementation have been evaluated, but there is currently no data to support their use. References 1. Ng, S.C., et al., Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies. Lancet, 2017. 390(10114): p. 2769-2778. 2. Watermeyer, G., et al., Epidemiology of inflammatory bowel disease in sub-Saharan Africa: A review of the current status. S Afr Med J, 2020. 110(10): p. 1006- 1009. 3. Hodges, P. and P. Kelly, Inflammatory bowel disease in Africa: what is the current state of knowledge? Int Health, 2020. 12(3): p. 222-230. 4. Kaplan, G.G. and J.W. Windsor, The four epidemiological stages in the global evolution of inflammatory bowel disease. Nat Rev Gastroenterol Hepatol, 2021. 18(1): p. 56-66. 5. Jess, T., C. Rungoe, and L. Peyrin-Biroulet, Risk of colorectal cancer in patients with ulcerative colitis: a meta-analysis of population-based cohort studies. Clin Gastroenterol Hepatol, 2012. 10(6): p. 639-45. 6. Olén, O., et al., Colorectal cancer in ulcerative colitis: a Scandinavian population-based cohort study. Lancet, 2020. 395(10218): p. 123-131. 7. Canavan, C., K.R. Abrams, and J. Mayberry, Meta- analysis: colorectal and small bowel cancer risk in patients with Crohn’s disease. Aliment Pharmacol Ther, 2006. 23(8): p. 1097-104. 8. Eaden, J.A., K.R. Abrams, and J.F. Mayberry, The risk of colorectal cancer in ulcerative colitis: a meta- analysis. Gut, 2001. 48(4): p. 526-35. 9. Selinger, C.P., et al., Long-term follow-up reveals low incidence of colorectal cancer, but frequent need for resection, among Australian patients with inflammatory bowel disease. Clin Gastroenterol Hepatol, 2014. 12(4): p. 644-50. 10. Birch, R.J., et al., Inflammatory Bowel Disease- Associated Colorectal Cancer Epidemiology and Outcomes: An English Population-Based Study. Am J Gastroenterol, 2022. 117(11): p. 1858-1870. 11. Ou, B., et al., Survival of Colorectal Cancer in Patients With or Without Inflammatory Bowel Disease: A Meta- Analysis. Dig Dis Sci, 2016. 61(3): p. 881-9. 12. Porter, R.J., et al., Inflammatory Bowel Disease- Associated Colorectal Cancer: Translational Risks from Mechanisms to Medicines. J Crohns Colitis, 2021. 15(12): p. 2131-2141. 13. Ullman, T.A. and S.H. Itzkowitz, Intestinal inflammation and cancer. Gastroenterology, 2011. 140(6): p. 1807-16. 14. Beaugerie, L. and S.H. Itzkowitz, Cancers complicating inflammatory bowel disease. N Engl J Med, 2015. 372(15): p. 1441-52. 15. 15.Abreu, M.T. and R.M. Peek, Jr., Gastrointestinal malignancy and the microbiome. Gastroenterology, 2014. 146(6): p. 1534-1546.e3. 16. Irrazábal, T., et al., The multifaceted role of the intestinal microbiota in colon cancer. Mol Cell, 2014. 54(2): p. 309-20. 17. Scarpa, M., et al., Inflammatory colonic carcinogenesis: a review on pathogenesis and immunosurveillance mechanisms in ulcerative colitis. World J Gastroenterol, 2014. 20(22): p. 6774-85. 18. Shah, S.C. and S.H. Itzkowitz, Colorectal Cancer in Inflammatory Bowel Disease: Mechanisms and Management. Gastroenterology, 2022. 162(3): p. 715- 730.e3. 19. Gordon, H., et al., ECCO Guidelines on Inflammatory Bowel Disease and Malignancies. J Crohns Colitis, 2022. 20. Farraye, F.A., et al., AGA technical review on the diagnosis and management of colorectal neoplasia in inflammatory bowel disease. Gastroenterology, 2010. 138(2): p. 746-74, 774.e1-4; quiz e12-3. 21. El-Dallal, M., et al., Meta-analysis of Virtual-based Chromoendoscopy Compared With Dye-spraying Chromoendoscopy Standard and High-definition White Light Endoscopy in Patients With Inflammatory Bowel Disease at Increased Risk of Colon Cancer. Inflamm Bowel Dis, 2020. 26(9): p. 1319-1329. 22. Lee, H., et al., Non-conventional dysplasia in inflammatory bowel disease is more frequently associated with advanced neoplasia and aneuploidy than conventional dysplasia. Histopathology, 2021. 78(6): p. 814-830. 23. Adamina, M., et al., ECCO Topical Review Optimising Reporting in Surgery, Endoscopy, and Histopathology. J Crohns Colitis, 2021. 15(7): p. 1089-1105. 24. Murthy, S.K., et al., AGA Clinical Practice Update on Endoscopic Surveillance and Management of Colorectal Dysplasia in Inflammatory Bowel Diseases: Expert Review. Gastroenterology, 2021. 161(3): p. 1043-1051.e4. 25. Laine, L., et al., SCENIC international consensus statement on surveillance and management of dysplasia in inflammatory bowel disease. Gastrointest Endosc, 2015. 81(3): p. 489-501.e26. 26. Wijnands, A.M., et al., Prognostic Factors for Advanced Colorectal Neoplasia in Inflammatory Bowel Disease: Systematic Review and Meta- analysis. Gastroenterology, 2021. 160(5): p. 1584- 1598. 27. Magro, F., et al., Third European Evidence-based Consensus on Diagnosis and Management of Ulcerative Colitis. Part 1: Definitions, Diagnosis, Extra-intestinal Manifestations, Pregnancy, Cancer Surveillance, Surgery, and Ileo-anal Pouch Disorders. J Crohns Colitis, 2017. 11(6): p. 649-670.