title: Association between serrated epithelial changes and colorectal dysplasia in inflammatory bowel disease.
abstract: OBJECTIVE
  Serrated epithelial change (SEC) is a histologic finding in longstanding colitis that may be associated with dysplasia. Our primary aim was to determine the incidence of dysplasia and colorectal cancer (CRC) in inflammatory bowel disease (IBD) patients with SEC. Secondary aims were to determine the rate of location concordance between SEC and dysplasia/CRC and to identify other risk factors associated with dysplasia in IBD patients with SEC.
  
  
  METHODS
  A retrospective, descriptive, observational study was performed by searching the Pathology Data System at a single tertiary referral center for a histologic finding of "serrated epithelial change." The patient's first pathology specimen with SEC was designated the index SEC. All subsequent pathology reports were evaluated for the occurrence and location of dysplasia or CRC. Univariable and multivariable logistic regression were performed to identify predictors of dysplasia.
  
  
  RESULTS
  There were 187 patients with confirmed IBD and 1 or more histologic findings of SEC without prior dysplasia. Mean IBD duration was 16 years, and median follow-up time was 28 months. The rate of high-grade dysplasia or CRC was 17 per 1000 patient-years. Thirty-nine of 187 patients (21%) had synchronous or metachronous dysplasia or CRC. Location concordance was 68%. Multivariable analysis found SEC on follow-up examinations, older age at IBD diagnosis, male gender, and a first-degree relative with CRC were associated with dysplasia in IBD patients with SEC.
  
  
  CONCLUSIONS
  This uncontrolled study describes a high frequency of dysplasia in patients with a histologic finding of SEC. SEC seen on successive endoscopic examinations further increased the risk of dysplasia. Further controlled studies are needed to determine if SEC is a precancerous lesion in IBD patients and if SEC can be endoscopically identified.
authors.affiliation: Division of Gastroenterology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
authors.forename: Alyssa
authors.initials: A
authors.lastname: Parian
authors.affiliation: Division of Gastroenterology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
authors.forename: Joyce
authors.initials: J
authors.lastname: Koh
authors.affiliation: Division of Gastroenterology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA; Division of Gastroenterology & Hepatology, Stanford University School of Medicine, Stanford, California, USA.
authors.forename: Berkeley N
authors.initials: BN
authors.lastname: Limketkai
authors.affiliation: Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
authors.forename: Swathi
authors.initials: S
authors.lastname: Eluri
authors.affiliation: Department of Medicine, University of Chicago, Chicago, Illinois, USA.
authors.forename: David T
authors.initials: DT
authors.lastname: Rubin
authors.affiliation: Division of Gastroenterology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
authors.forename: Steven R
authors.initials: SR
authors.lastname: Brant
authors.affiliation: Division of Gastroenterology, University of California Los Angeles, Los Angeles, California, USA.
authors.forename: Christina Y
authors.initials: CY
authors.lastname: Ha
authors.affiliation: Division of Gastroenterology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
authors.forename: Theodore M
authors.initials: TM
authors.lastname: Bayless
authors.affiliation: Division of Gastroenterology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
authors.forename: Francis
authors.initials: F
authors.lastname: Giardiello
authors.affiliation: Department of Pathology, University of Chicago, Chicago, Illinois, USA.
authors.forename: John
authors.initials: J
authors.lastname: Hart
authors.affiliation: Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Montgomery
authors.affiliation: Division of Gastroenterology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
authors.forename: Mark G
authors.initials: MG
authors.lastname: Lazarev
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology* / Q000473:pathology; D000236:Adenoma / Q000453:epidemiology* / Q000473:pathology; D000328:Adult; D000368:Aged; D003106:Colon / Q000473:pathology*; D015179:Colorectal Neoplasms / Q000453:epidemiology* / Q000473:pathology; D005260:Female; D006801:Humans; D015994:Incidence; D015212:Inflammatory Bowel Diseases / Q000453:epidemiology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D016017:Odds Ratio; D011230:Precancerous Conditions / Q000453:epidemiology* / Q000473:pathology; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D014481:United States