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Trends in Colorectal Dysplasia in Patients With IBD
John J Newland1, Joel Grunhut1, Rachael Belcher1
1Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland.
Diseases of the Colon and Rectum
|May 25, 2026
Summary
Inflammatory bowel disease (IBD) patients on immunotherapy, Asian Americans, and those with ulcerative colitis face higher colorectal dysplasia risk. Tailored surveillance is crucial for these high-risk groups.
Area of Science:
- Gastroenterology and Oncology
- Surgical Pathology
- Health Services Research
Background:
- Inflammatory bowel disease (IBD) patients have increased risk of early-onset colorectal cancer due to chronic inflammation and immunosuppression.
- Immunotherapy use in IBD may increase neoplastic transformation risk, requiring further investigation.
Purpose of the Study:
- To analyze trends in colorectal dysplasia incidence among IBD patients undergoing surgery.
- To identify clinical factors associated with dysplasia in this patient cohort.
Main Methods:
- Retrospective cohort study involving adult IBD patients undergoing colorectal surgery.
- Data from high-volume US IBD Centers within the American College of Surgeons National Surgery Quality Improvement Program IBD Collaborative (2017-2023).
- Analysis of surgical pathology for dysplasia prevalence and associated risk factors.
Main Results:
- Dysplasia identified in 4.3% of 5,516 IBD patients.
- Higher prevalence observed in ulcerative colitis (6.5%) vs. Crohn's disease (3.2%), and among Asian American patients (8.7%).
- Independent risk factors for dysplasia included immunotherapy use (OR 1.6), Asian American race (OR 2.54), ulcerative colitis (OR 2.0), and older age.
Conclusions:
- Immunotherapy, Asian American race, ulcerative colitis, and older age are independently associated with colorectal dysplasia in IBD patients undergoing surgery.
- Findings emphasize the need for personalized surveillance strategies in at-risk IBD populations, especially those on immunosuppressants.
- Study limitations include 30-day postoperative data capture and lack of information on surgical indication or dysplasia chronicity.
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