Race Does Not Affect the Prevalence of Sporadic Adenomas in Inflammatory Bowel Disease

Background: Sporadic adenoma formation found on surveillance colonoscopies in patients with inflammatory bowel disease (IBD) represents a significant risk for cancer. Certain racial groups like African Americans (AA) are at increased risk of developing colorectal cancer (CRC), but there is conflicting literature on differences in sporadic adenoma formation. Some data suggests AA are at increased risk for large adenomas, more proximal lesions, and increased prevalence. These data, however, are studying the general population and to our knowledge no study has looked at differences in adenoma formation by race in IBD patients. The present retrospective study analyzes the prevalence of adenomas in IBD patients. Methods: All IBD patients who received a surveillance colonoscopy within the past year were included in the present study. Sporadic adenomas included serrated, tubular, villous, and tubulovillous adenoma formation. A database was created using Microsoft Excel and identifying information was eliminated to ensure anonymity. Statistical analysis was performed using Fisher’s Exact Test, with statistical significance set at P\u3c0.05. Results: One hundred and thirty six patients with IBD were included, 34 (25%) of which were AA, 68 (50%) Caucasian, and 34 (25%) classified as other. Of the 136 patients, 58 had Crohn’s disease and 78 patients had ulcerative colitis. A total of 12 (8.8%) sporadic adenomas were found, 8 of which were serrated and 4 tubular. The incidence of sporadic adenomas were 4/34 (11.8%) among AA and 8/68 (11.8%) for Caucasians. The calculated P-value between these two groups is 1.0 (P\u3c0.05) using Fisher’s Exact Test. The average age of AA with adenomas was 44.7 years and 50.4 years in Caucasians. Average disease duration was 16.3 years in AA and 17.9 years in Caucasians. Discussion: IBD is known to increase the risk of developing colorectal cancers, especially through the inflammation-dysplasia pathway. Well-studied risk factors for CRC in IBD include duration, severity and extent of colitis, but a relationship between race and CRC risk has only been demonstrated in the general population, not IBD patients. There is even less data regarding the difference in sporadic adenoma formation between different races in IBD patients. While some literature suggests a difference in the prevalence of sporadic adenomas among AA and Caucasians in the general population, the present study found no such difference for our population of colitis patients. Additionally, the two groups did not differ greatly in average age or disease duration, which could have potentially served as confounding variables. The study of sporadic adenoma formation in IBD is still in its early stages. While differences in risk have not yet been well-characterized, further understanding of the molecular mechanisms underlying adenoma development might allow us to stratify risk more appropriately. At present, race does not seem to be an independent risk factor, so we should maintain a high index of suspicion of pre-neoplastic lesions in all IBD patients