Pseudopolyps are a well described entity in the literature and even though the exact pathogenesis of their formation is not completely understood, they are considered non-neoplastic lesions originating from the mucosa...Pseudopolyps are a well described entity in the literature and even though the exact pathogenesis of their formation is not completely understood, they are considered non-neoplastic lesions originating from the mucosa after repeated periods of inflammation and ulceration associated with excessive healing processes. Their occurrence is less common in Crohn's disease than in ulcerative colitis, and their overall prevalence ranges from 4% to 74%; moreover, they are found more often in colon but have been detected in other parts of the gastrointestinal tract as well. When their size exceeds the arbitrary point of 1.5 cm, they are classified as giant pseudopolyps. Clinical evaluation should differentiate the pseudopolyps from other polypoid lesions, such as the dysplasiaassociated mass or lesion, but this situation represents an ongoing clinical challenge. Pseudopolyps can provoke complications such as bleeding or obstruction, and their management includes medical therapy, endoscopy and surgery; however, no consensus exists about the optimal treatment approach. Patients with pseudopolyps are considered at intermediate risk for colorectal cancer and regular endoscopic monitoring is recommended. Through a review of the literature, we provide here a proposed classification of the characteristics of pseudopolyps.展开更多
Patients with inflammatory bowel diseases(IBD)represent heterogeneous groups with different characteristics and different clinical course.A great deal of effort is made to discover proxies for more severe disease need...Patients with inflammatory bowel diseases(IBD)represent heterogeneous groups with different characteristics and different clinical course.A great deal of effort is made to discover proxies for more severe disease needing more intense treatment and early intervention to gain the maximum therapeutic benefit.Endoscopy remains an invaluable method in assessment of patients with IBD.Pseudopolyps are often encountered during endoscopy and,although they are a well described entity,their presence is of unclear importance.In one of our recent studies and in conjunction with one study with a large cohort of patients with IBD and pseudopolyps,patients with pseudopolyps were found to face a higher inflammatory burden in terms of receiving more intense biological treatment.This letter comes as a comment and proposition regarding the concept of reevaluation of pseudopolyps as a promising marker in IBD scores.展开更多
Introduction: Inflammatory pseudopolyps (IPs) are a well-recognized entity in patients with inflammatory bowel disease (IBD), most likely developing from long-standing chronic inflammation. Similarly, IPs have been as...Introduction: Inflammatory pseudopolyps (IPs) are a well-recognized entity in patients with inflammatory bowel disease (IBD), most likely developing from long-standing chronic inflammation. Similarly, IPs have been associated with ischemic and infectious colitis, intestinal ulcers, and mucosal anastomoses. This study aimed to analyze inflammatory pseudopolyps without a history of these known associated pathologies. Materials and Methods: A database search was conducted for patients who underwent biopsies at Thomas Jefferson University Hospital from 2003-2013 for the presence of colorectal IPs. Exclusion criteria consisted of patients with a history of IBD, mucosal anastomoses, ischemic and infectious colitis. Spatial and temporal associations between colonic pathologies and IPs were assessed via Fisher’s exact and chi-square test, respectively. Results: Seventy-five polyps from 70 patients fulfilled the database search criteria. Forty-one pseudopolyps (55%) arose from the rectosigmoid region. Twenty-two patients had no associated colon pathology (31%);35 patients had epithelial polyps (50%), such as tubular adenomas, serrated adenomas, and hyperplastic polyps;10 patients had colonic adenocarcinoma (16%), and 18 patients had diverticulosis (26%). Epithelial polyps were significantly associated with IPs in the same region. However, diverticulosis was independent of IPs in regard to space and time. Conclusion: Colorectal inflammatory pseudopolyps may develop sporadically in up to one third of the cases while others frequently arise in the background of non-IBD colonic pathology. The increased presence of these polyps in the left colon raises the possibility that a subset of them may arise in predisposed mucosa. These polyps need to be differentiated from other morphologically similar colonic polyps.展开更多
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 ...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.展开更多
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 colonosc...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.展开更多
We present a case of a 19-year-old female who developed subacute obstruction due to giant inflammatory polyps,having undergone treatment for left-sided ulcerative colitis.This is followed by a review of the literature.
文摘Pseudopolyps are a well described entity in the literature and even though the exact pathogenesis of their formation is not completely understood, they are considered non-neoplastic lesions originating from the mucosa after repeated periods of inflammation and ulceration associated with excessive healing processes. Their occurrence is less common in Crohn's disease than in ulcerative colitis, and their overall prevalence ranges from 4% to 74%; moreover, they are found more often in colon but have been detected in other parts of the gastrointestinal tract as well. When their size exceeds the arbitrary point of 1.5 cm, they are classified as giant pseudopolyps. Clinical evaluation should differentiate the pseudopolyps from other polypoid lesions, such as the dysplasiaassociated mass or lesion, but this situation represents an ongoing clinical challenge. Pseudopolyps can provoke complications such as bleeding or obstruction, and their management includes medical therapy, endoscopy and surgery; however, no consensus exists about the optimal treatment approach. Patients with pseudopolyps are considered at intermediate risk for colorectal cancer and regular endoscopic monitoring is recommended. Through a review of the literature, we provide here a proposed classification of the characteristics of pseudopolyps.
文摘Patients with inflammatory bowel diseases(IBD)represent heterogeneous groups with different characteristics and different clinical course.A great deal of effort is made to discover proxies for more severe disease needing more intense treatment and early intervention to gain the maximum therapeutic benefit.Endoscopy remains an invaluable method in assessment of patients with IBD.Pseudopolyps are often encountered during endoscopy and,although they are a well described entity,their presence is of unclear importance.In one of our recent studies and in conjunction with one study with a large cohort of patients with IBD and pseudopolyps,patients with pseudopolyps were found to face a higher inflammatory burden in terms of receiving more intense biological treatment.This letter comes as a comment and proposition regarding the concept of reevaluation of pseudopolyps as a promising marker in IBD scores.
文摘Introduction: Inflammatory pseudopolyps (IPs) are a well-recognized entity in patients with inflammatory bowel disease (IBD), most likely developing from long-standing chronic inflammation. Similarly, IPs have been associated with ischemic and infectious colitis, intestinal ulcers, and mucosal anastomoses. This study aimed to analyze inflammatory pseudopolyps without a history of these known associated pathologies. Materials and Methods: A database search was conducted for patients who underwent biopsies at Thomas Jefferson University Hospital from 2003-2013 for the presence of colorectal IPs. Exclusion criteria consisted of patients with a history of IBD, mucosal anastomoses, ischemic and infectious colitis. Spatial and temporal associations between colonic pathologies and IPs were assessed via Fisher’s exact and chi-square test, respectively. Results: Seventy-five polyps from 70 patients fulfilled the database search criteria. Forty-one pseudopolyps (55%) arose from the rectosigmoid region. Twenty-two patients had no associated colon pathology (31%);35 patients had epithelial polyps (50%), such as tubular adenomas, serrated adenomas, and hyperplastic polyps;10 patients had colonic adenocarcinoma (16%), and 18 patients had diverticulosis (26%). Epithelial polyps were significantly associated with IPs in the same region. However, diverticulosis was independent of IPs in regard to space and time. Conclusion: Colorectal inflammatory pseudopolyps may develop sporadically in up to one third of the cases while others frequently arise in the background of non-IBD colonic pathology. The increased presence of these polyps in the left colon raises the possibility that a subset of them may arise in predisposed mucosa. These polyps need to be differentiated from other morphologically similar colonic polyps.
基金Supported by the National Natural Science Foundation of China,No.81660093.
文摘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.
基金The National Key R&D Program of China,No.2017YFC1308800National Natural Science Foundation of China,No.81970482+3 种基金Natural Science Foundation of Guangdong Province,China,No.2019A1515011313Sun Yat-Sen University 5010 Project,No.2010012the Fundamental Research Funds for the Central Universities,No.19ykpy05National Key Clinical Discipline.
文摘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.
文摘We present a case of a 19-year-old female who developed subacute obstruction due to giant inflammatory polyps,having undergone treatment for left-sided ulcerative colitis.This is followed by a review of the literature.
