Garrett Lawlor - Academia.edu (original) (raw)

Papers by Garrett Lawlor

World Journal of Gastrointestinal Pharmacology and Therapeutics, 2014

Methotrexate has been used an immunomodulator in many autoimmune diseases, including inflammatory... more Methotrexate has been used an immunomodulator in many autoimmune diseases, including inflammatory bowel disease. However, many physicians are unfamiliar or uncomfortable with its use in the management of inflammatory bowel disease. We summarize the data for use of methotrexate in common clinical scenarios:

Inflammatory Bowel Diseases, 2009

imaging technique providing noninvasive, three-dimensional, whole-body, quantitative images. The ... more imaging technique providing noninvasive, three-dimensional, whole-body, quantitative images. The primary use of PET is in tumor detection and staging. More recently, it has been shown to be of value in assessing patients with inflammatory processes. To date the role of PET in the management of patients with inflammatory bowel disease (IBD) has not been defined.

Data Revues 00165107 V61i5 S0016510705006255, Aug 18, 2011

Journal of Clinical Gastroenterology, 2005

Introduction: Current guidelines endorse colon cancer screening every 5-10 years in patients over... more Introduction: Current guidelines endorse colon cancer screening every 5-10 years in patients over 50 years regardless of age beyond 50 years or gender. However, individual patients' risks may vary according to age and gender. This study aimed to characterize neoplasia occurrence in a large patient cohort undergoing colonoscopy. Methods: All patients undergoing 2 colonoscopies at least 12 months apart between 1996 and 2000, with normal findings on the index colonoscopy, were identified using our endoscopic database to determine the incidence of colonic neoplasia. Patients were classified according to a) age: !50, 50-64, 65-74, R75 years, and b) gender. Results: Overall, 2,041 patients underwent two colonoscopies at least 12 months apart (median interval, 154 weeks) with normal findings on initial examination. On subsequent endoscopy, polyps R5 mm were detected in 151 (7.4%) patients and polyps R10 mm in 50 (2.5%). Kaplan-Meier curve (figure) for neoplasia occurrence demonstrated similar rates for all patients R65 years (log rank test). Using a Cox proportional hazards model, hazard ratios (95% C.I.) for neoplasia (polyps R5 mm and R10 mm) demonstrated equivalent neoplasia rates among gender and age groups R65 years; however rates in females aged 50-64 were lower than age-matched males (table). Conclusions: Rates of incident neoplasia are similar among patients of different gender and age groups over 65 years on screening colonoscopy; rates in females aged 50-64 are lower than age-matched males. From a health resource utilization perspective, these findings support current recommendations for similar screening intervals for patients over 65 years regardless of age and gender. However, consideration could be given to commencing screening at age 50 in males and age 65 in females.

Current treatment options in gastroenterology, 2015

The management of inflammatory bowel disease (IBD) in patients with known or recently treated can... more The management of inflammatory bowel disease (IBD) in patients with known or recently treated cancer has become a common dilemma in our ageing population. Older patients are commonly excluded from prospective trials, and co-morbid status and polypharmacy may muddy our understanding of the impact of therapies on these patients. Immunosuppression (anti-TNF therapy, antimetabolite therapy) carries a relative contra-indication in the setting of known cancer as it is expected to increase cancer risk and increase propagation of in situ cancer. Recent studies have sought to investigate this risk by looking from two sides-the impact of cancer therapies on IBD outcomes and the risk of cancer occurrence/recurrence in patients on IBD therapies. In this chapter, we review this data and determine the safety of commonly used IBD therapies in this potentially vulnerable elderly population.

Journal of Experimental & Clinical Cancer Research, 2010

We have previously reported that Myeov (MYEloma OVerexpressed gene) expression is enhanced in col... more We have previously reported that Myeov (MYEloma OVerexpressed gene) expression is enhanced in colorectal cancer (CRC) and that it promotes CRC cell proliferation and invasion. The role of Myeov in CRC migration is unclear. ProstaglandinE2 (PGE 2 ) is a known factor in promoting CRC carcinogenesis. The role of PGE 2 in modulating Myeov expression has also not been defined.

Journal of Clinical Gastroenterology, 2014

Recent studies have identified subgroups of inflammatory bowel disease (IBD) patients at increase... more Recent studies have identified subgroups of inflammatory bowel disease (IBD) patients at increased likelihood for developing primary sclerosing cholangitis (PSC). Most studies look at predominantly white populations. The aim of our study was to determine the characteristics of PSC in a black cohort of patients and its relationship to disease location in IBD. A retrospective analysis was performed on IBD patients over the age of 18 years. Of the 209 black patients identified as having IBD, 7 (3.5%) had a concomitant diagnosis of PSC; 5/138 (3.6%) ulcerative colitis (UC) patients, and 2/71 (2.8%) Crohn's disease patients (CD). Numerically, more males developed PSC in both the UC and CD subgroups. Age at diagnosis of IBD tended to be younger among PSC cohorts. All PSC-UC patients had pancolitis (P<0.0001), and all PSC-CD patients had a colonic component to their disease. In the UC cohort, PSC patients were statistically more likely to be on immunosuppressive therapy (P<0.0001). With greater research, physicians will better recognize IBD phenotypes at highest risk of PSC and hopefully identify complications of PSC, including cholangiocarcinoma.

Inflammatory Bowel Diseases, 2013

ABSTRACT BACKGROUND: The relationship between ulcerative colitis (UC) and Human Immunodeficiency ... more ABSTRACT BACKGROUND: The relationship between ulcerative colitis (UC) and Human Immunodeficiency Virus (HIV) is largely understudied to date, owing mainly to the relative rarity of both diseases. Considering UC flares are mediated by CD4+ T-cell dysregulation, it has been suggested that the immunosuppressive effects of HIV may concomitantly suppress UC activity. The aim of our study is to evaluate the impact of HIV and suppressed CD4 count on UC phenotype and relapse risk.METHODS: Eight patients with HIV and UC were identified in a 10 year retrospective database of inflammatory bowel disease (IBD) patients seen at an urban medical center. Information regarding patients' UC, HIV status, and CD4+ count was collected. A UC disease flare was defined as bloody diarrhea, increase in stool frequency, and/or tenesmus, with alternate diagnoses ruled out. A value of CD4+ count of <500 was used to define immunosuppression.RESULTS: Eight patients were identified that had both HIV and UC. Six were male and 2 were female with a median age of 45 years, range 28-58 years. Four (50%) patients had pancolitis (with a median duration of disease of 5.5 years), 1 had extensive colitis, 2 had rectal disease, and 1 disease extent was unknown. HIV was diagnosed prior to UC in 7/8 (87.5%) patients with a median time lag between diagnoses of 3.5 years (range 1-10 years). The median duration of follow up was 3 years (range 1-6 years). The 8 patients experienced a median flare rate of 0.85 flares per year. There were 23 documented flares amongst 8 UC/HIV patients; 14 of these flares had concomitant, documented CD4 counts. Of the 14 episodes of UC flare with CD4 counts, 5/14 (35.7%) UC flares occurred with normal CD4 counts, whereas 9/14 (64.3%) UC flares occurred while immunosuppressed (CD4+ count <500). 9/23 (39.1%) UC flares required systemic corticosteroids in addition to topical therapy to induce clinical disease remission and 2/23 (8.7%) required anti-TNF therapy to induce remission, while 10/23 (43.5%) disease flares subsided with topical therapy alone; the medications used for 2/23 (8.7%) disease flares were unknown.CONCLUSIONS: Our findings suggest that CD4 count is not an inverse predictor of disease relapse in patients with known ulcerative colitis- over 64% of proven UC flares occurred when patients had depressed CD4 counts. We also identified that these patients have a phenotypic predilection to pancolitis (50% of UC/HIV patients with a median follow up of 5.5 years) with a high flare rate (0.85 flares/year). Whether HIV directly influences relapse risk in this cohort remains to be seen- severe disease may relate to a sicker patient cohort rather than the underlying disease process. However, the observation that CD4 count does not impact relapse risk refutes previous thoughts that patients with HIV related immunosuppression are relatively protected against UC flares.(C) Crohn's & Colitis Foundation of America, Inc.

Inflammatory Bowel Diseases, 2013

ABSTRACT BACKGROUND: The incidence of Clostridium difficile infection (CDI) has been increasing o... more ABSTRACT BACKGROUND: The incidence of Clostridium difficile infection (CDI) has been increasing over the past decade. Patients with Crohn's disease (CD) and ulcerative colitis (UC) who acquire CDI have worse outcomes with higher rates of hospitalization, surgery and mortality when compared to non-IBD CDI patients. Racial variation in IBD patients infected with C. difficile has been poorly described. The aim of our present study is to assess the risk of CDI in Afro-Caribbean patients hospitalized with a suspected IBD flare.METHODS: A retrospective cohort analysis was conducted for all Afro-Caribbean IBD patients admitted with suspected flare to an urban medical center. Information regarding ethnic background, disease classification (UC versus CD), IBD related hospitalizations (using chief complaint of diarrhea, abdominal pain, or IBD flare) and CDI positivity was collected from the years 2006-2013.RESULTS: Two hundred forty-one IBD-related hospitalizations were identified, of which CDI testing was performed in 110. Of these 110 hospitalizations, 11 (10%) proved positive for CDI. Comparing to the number of IBD patients with diarrhea tested for CDI, 3/58 (5.2%) of UC patients were CDI+, 7/42 (16.7%) of CD patients were CDI +, and 1/10 (10%) of indeterminate colitis patients were CDI+.CONCLUSIONS: In our cohort of Afro-Caribbean patients with previously diagnosed IBD, Crohn's disease carried a higher than previously reported rate (16.7%) of contracting clinically significant Clostridium difficile infection. Rate of CDI amongst UC patients (5.2%) remained in line with other studies. This study emphasizes the role of C. difficile infection in IBD flares, particularly amongst Crohn's disease flares in an Afro-Caribbean population.(C) Crohn's & Colitis Foundation of America, Inc.

Inflammatory Bowel Diseases, 2013

Patients with ulcerative colitis (UC) who are in clinical remission may still have underlying end... more Patients with ulcerative colitis (UC) who are in clinical remission may still have underlying endoscopic inflammation, which is associated with inferior clinical outcomes. The goal of this study was to determine the prevalence of active endoscopic disease, and factors associated with it, in patients with UC who are in clinical remission. Prospective observational study in a single center. Patients with UC in clinical remission (by Simple Clinical Colitis Activity Index) were enrolled prospectively at the time of surveillance colonoscopy. Disease phenotype, endoscopic activity (Mayo subscore), and histologic score (Geboes) were recorded, and blood was drawn for peripheral blood biomarkers. Overall, 149 patients in clinical remission were prospectively enrolled in this cohort; 81% had been in clinical remission for >6 months, and 86% were currently prescribed maintenance medications. At endoscopy, 45% of patients in clinical remission had any endoscopic inflammation (Mayo endoscopy subscore >0), and 13% had scores >1. In a multivariate model, variables independently associated with a Mayo endoscopic score >1 were remission for <6 months (P = 0.001), white blood count (P = 0.01), and C-reactive protein level (P = 0.009). A model combining these 3 variables had a sensitivity of 94% and a specificity of 73% for predicting moderate-to-severe endoscopic activity in patients in clinical remission (area under the curve, 0.86). In an unselected subgroup of patients who had peripheral blood mononuclear cell messenger RNA profiling, GATA3 messenger RNA levels were significantly higher in patients with endoscopic activity. Duration of clinical remission, white blood count, and C-reactive protein level can predict the probability of ongoing endoscopic activity, despite clinical remission in patients with UC. These parameters could be used to identify patients who require intensification of treatment to achieve mucosal healing.

Inflammatory Bowel Diseases, 2010

Inflammatory Bowel Diseases, 2011

Gastrointestinal Endoscopy, 2005

Introduction: Current guidelines endorse colon cancer screening every 5-10 years in patients over... more Introduction: Current guidelines endorse colon cancer screening every 5-10 years in patients over 50 years. However, relative utility of colonoscopy or flexible sigmoidoscopy depends on the risk of proximal vs. distal neoplasia in individual patients. Characterizing risk of proximal/distal neoplasia according to age could theoretically assist in tailoring screening approach and optimize resource utilization. This study aimed to characterize location of neoplasia occurrence in a large patient cohort undergoing screening colonoscopy. Methods: All patients undergoing 2 colonoscopies at least 12 months apart between 1996 and 2000, with normal findings on the index colonoscopy, were identified using our endoscopic database to determine the incidence of colonic neoplasia. Patients were classified according to age: !50, 50-64, 65-74, R75 years. Location and size of lesion on subsequent colonoscopy was analyzed. Results: Overall, 2,041 patients underwent two colonoscopies at least 12 months apart (median interval, 154 weeks) with normal findings on initial examination. On subsequent endoscopy, polyps R5 mm were detected in 151 (7.4%) patients -proximal in 76 and distal in 75 -and polyps R10 mm in 50 (2.5%) -proximal in 28 and distal in 22. Using a Cox proportional hazards model, adjusted hazard ratios (95% C.I.) for proximal and distal neoplasia (all sizes [figure], R10 mm) demonstrated a proportionately higher increase for proximal neoplasia development with advancing patient age (table). Conclusions: Both incident proximal and distal neoplasia increase with advancing age, although the proportional increase in proximal lesions is higher than for distal lesions. From a health resource utilization perspective, these findings support the broader use of colonoscopy rather than flexible sigmoidoscopy as a screening modality especially in older patients in whom proximal lesions become increasingly prevalent.

World Journal of Gastrointestinal Pharmacology and Therapeutics, 2014

Methotrexate has been used an immunomodulator in many autoimmune diseases, including inflammatory... more Methotrexate has been used an immunomodulator in many autoimmune diseases, including inflammatory bowel disease. However, many physicians are unfamiliar or uncomfortable with its use in the management of inflammatory bowel disease. We summarize the data for use of methotrexate in common clinical scenarios:

Inflammatory Bowel Diseases, 2009

imaging technique providing noninvasive, three-dimensional, whole-body, quantitative images. The ... more imaging technique providing noninvasive, three-dimensional, whole-body, quantitative images. The primary use of PET is in tumor detection and staging. More recently, it has been shown to be of value in assessing patients with inflammatory processes. To date the role of PET in the management of patients with inflammatory bowel disease (IBD) has not been defined.

Data Revues 00165107 V61i5 S0016510705006255, Aug 18, 2011

Journal of Clinical Gastroenterology, 2005

Introduction: Current guidelines endorse colon cancer screening every 5-10 years in patients over... more Introduction: Current guidelines endorse colon cancer screening every 5-10 years in patients over 50 years regardless of age beyond 50 years or gender. However, individual patients' risks may vary according to age and gender. This study aimed to characterize neoplasia occurrence in a large patient cohort undergoing colonoscopy. Methods: All patients undergoing 2 colonoscopies at least 12 months apart between 1996 and 2000, with normal findings on the index colonoscopy, were identified using our endoscopic database to determine the incidence of colonic neoplasia. Patients were classified according to a) age: !50, 50-64, 65-74, R75 years, and b) gender. Results: Overall, 2,041 patients underwent two colonoscopies at least 12 months apart (median interval, 154 weeks) with normal findings on initial examination. On subsequent endoscopy, polyps R5 mm were detected in 151 (7.4%) patients and polyps R10 mm in 50 (2.5%). Kaplan-Meier curve (figure) for neoplasia occurrence demonstrated similar rates for all patients R65 years (log rank test). Using a Cox proportional hazards model, hazard ratios (95% C.I.) for neoplasia (polyps R5 mm and R10 mm) demonstrated equivalent neoplasia rates among gender and age groups R65 years; however rates in females aged 50-64 were lower than age-matched males (table). Conclusions: Rates of incident neoplasia are similar among patients of different gender and age groups over 65 years on screening colonoscopy; rates in females aged 50-64 are lower than age-matched males. From a health resource utilization perspective, these findings support current recommendations for similar screening intervals for patients over 65 years regardless of age and gender. However, consideration could be given to commencing screening at age 50 in males and age 65 in females.

Current treatment options in gastroenterology, 2015

The management of inflammatory bowel disease (IBD) in patients with known or recently treated can... more The management of inflammatory bowel disease (IBD) in patients with known or recently treated cancer has become a common dilemma in our ageing population. Older patients are commonly excluded from prospective trials, and co-morbid status and polypharmacy may muddy our understanding of the impact of therapies on these patients. Immunosuppression (anti-TNF therapy, antimetabolite therapy) carries a relative contra-indication in the setting of known cancer as it is expected to increase cancer risk and increase propagation of in situ cancer. Recent studies have sought to investigate this risk by looking from two sides-the impact of cancer therapies on IBD outcomes and the risk of cancer occurrence/recurrence in patients on IBD therapies. In this chapter, we review this data and determine the safety of commonly used IBD therapies in this potentially vulnerable elderly population.

Journal of Experimental & Clinical Cancer Research, 2010

We have previously reported that Myeov (MYEloma OVerexpressed gene) expression is enhanced in col... more We have previously reported that Myeov (MYEloma OVerexpressed gene) expression is enhanced in colorectal cancer (CRC) and that it promotes CRC cell proliferation and invasion. The role of Myeov in CRC migration is unclear. ProstaglandinE2 (PGE 2 ) is a known factor in promoting CRC carcinogenesis. The role of PGE 2 in modulating Myeov expression has also not been defined.

Journal of Clinical Gastroenterology, 2014

Recent studies have identified subgroups of inflammatory bowel disease (IBD) patients at increase... more Recent studies have identified subgroups of inflammatory bowel disease (IBD) patients at increased likelihood for developing primary sclerosing cholangitis (PSC). Most studies look at predominantly white populations. The aim of our study was to determine the characteristics of PSC in a black cohort of patients and its relationship to disease location in IBD. A retrospective analysis was performed on IBD patients over the age of 18 years. Of the 209 black patients identified as having IBD, 7 (3.5%) had a concomitant diagnosis of PSC; 5/138 (3.6%) ulcerative colitis (UC) patients, and 2/71 (2.8%) Crohn's disease patients (CD). Numerically, more males developed PSC in both the UC and CD subgroups. Age at diagnosis of IBD tended to be younger among PSC cohorts. All PSC-UC patients had pancolitis (P<0.0001), and all PSC-CD patients had a colonic component to their disease. In the UC cohort, PSC patients were statistically more likely to be on immunosuppressive therapy (P<0.0001). With greater research, physicians will better recognize IBD phenotypes at highest risk of PSC and hopefully identify complications of PSC, including cholangiocarcinoma.

Inflammatory Bowel Diseases, 2013

ABSTRACT BACKGROUND: The relationship between ulcerative colitis (UC) and Human Immunodeficiency ... more ABSTRACT BACKGROUND: The relationship between ulcerative colitis (UC) and Human Immunodeficiency Virus (HIV) is largely understudied to date, owing mainly to the relative rarity of both diseases. Considering UC flares are mediated by CD4+ T-cell dysregulation, it has been suggested that the immunosuppressive effects of HIV may concomitantly suppress UC activity. The aim of our study is to evaluate the impact of HIV and suppressed CD4 count on UC phenotype and relapse risk.METHODS: Eight patients with HIV and UC were identified in a 10 year retrospective database of inflammatory bowel disease (IBD) patients seen at an urban medical center. Information regarding patients' UC, HIV status, and CD4+ count was collected. A UC disease flare was defined as bloody diarrhea, increase in stool frequency, and/or tenesmus, with alternate diagnoses ruled out. A value of CD4+ count of <500 was used to define immunosuppression.RESULTS: Eight patients were identified that had both HIV and UC. Six were male and 2 were female with a median age of 45 years, range 28-58 years. Four (50%) patients had pancolitis (with a median duration of disease of 5.5 years), 1 had extensive colitis, 2 had rectal disease, and 1 disease extent was unknown. HIV was diagnosed prior to UC in 7/8 (87.5%) patients with a median time lag between diagnoses of 3.5 years (range 1-10 years). The median duration of follow up was 3 years (range 1-6 years). The 8 patients experienced a median flare rate of 0.85 flares per year. There were 23 documented flares amongst 8 UC/HIV patients; 14 of these flares had concomitant, documented CD4 counts. Of the 14 episodes of UC flare with CD4 counts, 5/14 (35.7%) UC flares occurred with normal CD4 counts, whereas 9/14 (64.3%) UC flares occurred while immunosuppressed (CD4+ count <500). 9/23 (39.1%) UC flares required systemic corticosteroids in addition to topical therapy to induce clinical disease remission and 2/23 (8.7%) required anti-TNF therapy to induce remission, while 10/23 (43.5%) disease flares subsided with topical therapy alone; the medications used for 2/23 (8.7%) disease flares were unknown.CONCLUSIONS: Our findings suggest that CD4 count is not an inverse predictor of disease relapse in patients with known ulcerative colitis- over 64% of proven UC flares occurred when patients had depressed CD4 counts. We also identified that these patients have a phenotypic predilection to pancolitis (50% of UC/HIV patients with a median follow up of 5.5 years) with a high flare rate (0.85 flares/year). Whether HIV directly influences relapse risk in this cohort remains to be seen- severe disease may relate to a sicker patient cohort rather than the underlying disease process. However, the observation that CD4 count does not impact relapse risk refutes previous thoughts that patients with HIV related immunosuppression are relatively protected against UC flares.(C) Crohn's & Colitis Foundation of America, Inc.

Inflammatory Bowel Diseases, 2013

ABSTRACT BACKGROUND: The incidence of Clostridium difficile infection (CDI) has been increasing o... more ABSTRACT BACKGROUND: The incidence of Clostridium difficile infection (CDI) has been increasing over the past decade. Patients with Crohn's disease (CD) and ulcerative colitis (UC) who acquire CDI have worse outcomes with higher rates of hospitalization, surgery and mortality when compared to non-IBD CDI patients. Racial variation in IBD patients infected with C. difficile has been poorly described. The aim of our present study is to assess the risk of CDI in Afro-Caribbean patients hospitalized with a suspected IBD flare.METHODS: A retrospective cohort analysis was conducted for all Afro-Caribbean IBD patients admitted with suspected flare to an urban medical center. Information regarding ethnic background, disease classification (UC versus CD), IBD related hospitalizations (using chief complaint of diarrhea, abdominal pain, or IBD flare) and CDI positivity was collected from the years 2006-2013.RESULTS: Two hundred forty-one IBD-related hospitalizations were identified, of which CDI testing was performed in 110. Of these 110 hospitalizations, 11 (10%) proved positive for CDI. Comparing to the number of IBD patients with diarrhea tested for CDI, 3/58 (5.2%) of UC patients were CDI+, 7/42 (16.7%) of CD patients were CDI +, and 1/10 (10%) of indeterminate colitis patients were CDI+.CONCLUSIONS: In our cohort of Afro-Caribbean patients with previously diagnosed IBD, Crohn's disease carried a higher than previously reported rate (16.7%) of contracting clinically significant Clostridium difficile infection. Rate of CDI amongst UC patients (5.2%) remained in line with other studies. This study emphasizes the role of C. difficile infection in IBD flares, particularly amongst Crohn's disease flares in an Afro-Caribbean population.(C) Crohn's & Colitis Foundation of America, Inc.

Inflammatory Bowel Diseases, 2013

Patients with ulcerative colitis (UC) who are in clinical remission may still have underlying end... more Patients with ulcerative colitis (UC) who are in clinical remission may still have underlying endoscopic inflammation, which is associated with inferior clinical outcomes. The goal of this study was to determine the prevalence of active endoscopic disease, and factors associated with it, in patients with UC who are in clinical remission. Prospective observational study in a single center. Patients with UC in clinical remission (by Simple Clinical Colitis Activity Index) were enrolled prospectively at the time of surveillance colonoscopy. Disease phenotype, endoscopic activity (Mayo subscore), and histologic score (Geboes) were recorded, and blood was drawn for peripheral blood biomarkers. Overall, 149 patients in clinical remission were prospectively enrolled in this cohort; 81% had been in clinical remission for >6 months, and 86% were currently prescribed maintenance medications. At endoscopy, 45% of patients in clinical remission had any endoscopic inflammation (Mayo endoscopy subscore >0), and 13% had scores >1. In a multivariate model, variables independently associated with a Mayo endoscopic score >1 were remission for <6 months (P = 0.001), white blood count (P = 0.01), and C-reactive protein level (P = 0.009). A model combining these 3 variables had a sensitivity of 94% and a specificity of 73% for predicting moderate-to-severe endoscopic activity in patients in clinical remission (area under the curve, 0.86). In an unselected subgroup of patients who had peripheral blood mononuclear cell messenger RNA profiling, GATA3 messenger RNA levels were significantly higher in patients with endoscopic activity. Duration of clinical remission, white blood count, and C-reactive protein level can predict the probability of ongoing endoscopic activity, despite clinical remission in patients with UC. These parameters could be used to identify patients who require intensification of treatment to achieve mucosal healing.

Inflammatory Bowel Diseases, 2010

Inflammatory Bowel Diseases, 2011

Gastrointestinal Endoscopy, 2005

Introduction: Current guidelines endorse colon cancer screening every 5-10 years in patients over... more Introduction: Current guidelines endorse colon cancer screening every 5-10 years in patients over 50 years. However, relative utility of colonoscopy or flexible sigmoidoscopy depends on the risk of proximal vs. distal neoplasia in individual patients. Characterizing risk of proximal/distal neoplasia according to age could theoretically assist in tailoring screening approach and optimize resource utilization. This study aimed to characterize location of neoplasia occurrence in a large patient cohort undergoing screening colonoscopy. Methods: All patients undergoing 2 colonoscopies at least 12 months apart between 1996 and 2000, with normal findings on the index colonoscopy, were identified using our endoscopic database to determine the incidence of colonic neoplasia. Patients were classified according to age: !50, 50-64, 65-74, R75 years. Location and size of lesion on subsequent colonoscopy was analyzed. Results: Overall, 2,041 patients underwent two colonoscopies at least 12 months apart (median interval, 154 weeks) with normal findings on initial examination. On subsequent endoscopy, polyps R5 mm were detected in 151 (7.4%) patients -proximal in 76 and distal in 75 -and polyps R10 mm in 50 (2.5%) -proximal in 28 and distal in 22. Using a Cox proportional hazards model, adjusted hazard ratios (95% C.I.) for proximal and distal neoplasia (all sizes [figure], R10 mm) demonstrated a proportionately higher increase for proximal neoplasia development with advancing patient age (table). Conclusions: Both incident proximal and distal neoplasia increase with advancing age, although the proportional increase in proximal lesions is higher than for distal lesions. From a health resource utilization perspective, these findings support the broader use of colonoscopy rather than flexible sigmoidoscopy as a screening modality especially in older patients in whom proximal lesions become increasingly prevalent.