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dc.contributor.authorChoi, C-HRen_US
dc.contributor.authorAl Bakir, Ien_US
dc.contributor.authorDing, N-SJen_US
dc.contributor.authorLee, G-Hen_US
dc.contributor.authorAskari, Aen_US
dc.contributor.authorWarusavitarne, Jen_US
dc.contributor.authorMoorghen, Men_US
dc.contributor.authorHumphries, Aen_US
dc.contributor.authorIgnjatovic-Wilson, Aen_US
dc.contributor.authorThomas-Gibson, Sen_US
dc.contributor.authorSaunders, BPen_US
dc.contributor.authorRutter, MDen_US
dc.contributor.authorGraham, TAen_US
dc.contributor.authorHart, ALen_US
dc.date.accessioned2018-01-22T10:02:15Z
dc.date.available2017-10-12en_US
dc.date.issued2017-11-17en_US
dc.date.submitted2018-01-17T13:58:40.121Z
dc.identifier.urihttp://qmro.qmul.ac.uk/xmlui/handle/123456789/31463
dc.description.abstractOBJECTIVE: Ulcerative colitis (UC) is a dynamic disease with its severity continuously changing over time. We hypothesised that the risk of colorectal neoplasia (CRN) in UC closely follows an actuarial accumulative inflammatory burden, which is inadequately represented by current risk stratification strategies. DESIGN: This was a retrospective single-centre study. Patients with extensive UC who were under colonoscopic surveillance between 2003 and 2012 were studied. Each surveillance episode was scored for a severity of microscopic inflammation (0=no activity; 1=mild; 2=moderate; 3=severe activity). The cumulative inflammatory burden (CIB) was defined as sum of: average score between each pair of surveillance episodes multiplied by the surveillance interval in years. Potential predictors were correlated with CRN outcome using time-dependent Cox regression. RESULTS: A total of 987 patients were followed for a median of 13 years (IQR, 9-18), 97 (9.8%) of whom developed CRN. Multivariate analysis showed that the CIB was significantly associated with CRN development (HR, 2.1 per 10-unit increase in CIB (equivalent of 10, 5 or 3.3 years of continuous mild, moderate or severe active microscopic inflammation); 95% CI 1.4 to 3.0; P<0.001). Reflecting this, while inflammation severity based on the most recent colonoscopy alone was not significant (HR, 0.9 per-1-unit increase in severity; 95% CI 0.7 to 1.2; P=0.5), a mean severity score calculated from all colonoscopies performed in preceding 5 years was significantly associated with CRN risk (HR, 2.2 per-1-unit increase; 95% CI 1.6 to 3.1; P<0.001). CONCLUSION: The risk of CRN in UC is significantly associated with accumulative inflammatory burden. An accurate CRN risk stratification should involve assessment of multiple surveillance episodes to take this into account.en_US
dc.description.sponsorshipThe authors acknowledge funding from Cancer Research UK (A19771 to TAG), the Wellcome Trust (202778/Z/16/Z to TAG) and the Barts Charity (472/2300 to TAG). C-HRC was funded by a studentship from the Derek Willoughby Fund for Inflammatory Research, and IAB is funded by a studentship from the UK Medical Research Council.en_US
dc.languageengen_US
dc.language.isoenen_US
dc.relation.ispartofGuten_US
dc.rightsCC BY 4.0
dc.subjectcolonoscopyen_US
dc.subjectcolorectal cancer screeningen_US
dc.subjectcolorectal neoplasiaen_US
dc.subjectinflammationen_US
dc.subjectsurveillanceen_US
dc.titleCumulative burden of inflammation predicts colorectal neoplasia risk in ulcerative colitis: a large single-centre study.en_US
dc.typeArticle
dc.rights.holder(c) The Authors, 2017.
dc.identifier.doi10.1136/gutjnl-2017-314190en_US
pubs.author-urlhttps://www.ncbi.nlm.nih.gov/pubmed/29150489en_US
pubs.notesNo embargoen_US
pubs.notesPublished open accessen_US
pubs.publication-statusPublished onlineen_US
dcterms.dateAccepted2017-10-12en_US


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