Colorectal adenomas in patients presenting with inflammatory bowel disease

Adenoma is the precursor of colorectal carcinoma (CRC). Patients with longstanding active ulcerative colitis (UC) are at risk of developing CRC. Every patient with UC can also develop adenomas, which is an extra risk factor.

A large retrospective cross-sectional study was conducted to identify patients with UC and polyps.

All consecutive lower intestinal endoscopies carried out in a period of 16 years were searched for the presence of inflammation and concomitant polyps.

Inflammatory bowel disease was diagnosed in 1029 patients. Forty-seven (4.5%) patients had concomitant polyps. The patients with polyps were divided in two groups: group 1 consisted of 34 patients in whom active inflammation was seen with coinciding polyp(s), and group 2 consisted of 12 patients in remission, in whom polyps were detected. One patient had had adenomas in the past and presented with active inflammation and a new adenoma. In group 1, four patients had a history of active inflammation, and adenomas were seen in 29 patients, while seven patients showed hyperplastic polyps. Two patients had adenomas as well as hyperplastic polyps. In group 2 nine patients had adenomas and three had hyperplastic polyps.

Patients with different phenotypic expressions of inflammatory bowel disease can have concomitant adenomas in the colon. Hence, it is plausible to assume that these patients have an increased risk of developing CRC because of adenomas.