Aurada Cholapranee, MD, Keith Sultan, MD, Charles J. Pohanka, IV, BA
Northwell Health System, Manhasset, NY
Introduction: The Centers for Disease Control and Prevention reports an estimated incidence rate of IBD between 17.7-28.9 cases per 100,000 person years. While IBD is typically associated with visible mucosal abnormalities studies have shown that up to 40% of patients with suspected IBD and normal appearing mucosa have evidence of inflammation on biopsy. Lymphoid aggregates (LA) are often found on histopathology in cases of known or suspected IBD, along with more characteristic findings of chronic inflammation, crypt distortion/abscesses. However, the significance of isolated LA without other abnormal histopathology is unknown. We hypothesized that isolated LA may be a marker of future onset IBD.
Methods: We conducted a retrospective study using a patient database at the Endoscopy Center of Long Island, part of Northwell Health system. A database query was conducted of all colonoscopy reports for adults > 18 years of age during the years of 2006-2011. These reports were reviewed for associated histopathology reports describing LA. Patient were excluded if the histopathology reported any finding suggestive or diagnostic of IBD other than LA. Only patients with a followup colonoscopy were included in final analysis. Patient medical records were further used to exclude those with a documented IBD history or use of IBD medication. A diagnosis of IBD on follow up colonoscopy was determined by endoscopic and microscopic findings. The primary analysis used exact binomial methods to compute an exact 95% CI for IBD diagnosis incidence rate as compared to the CDC estimated IBD incidence rate.
Results: 39,680 patients had colonoscopies during the study period. Of these, 767 patients had evidence of LA. 539 (1.36%) demonstrated isolated LA without other evidence of inflammation. Of these, 284 met the requirement of a follow up colonoscopy. 165 were excluded due to documented history of IBD, leaving 119 subjects for analysis. Of these, 5 developed IBD. The median time from initial colonoscopy to diagnosis of IBD was 6.29 years. The observed incidence of IBD in our study group was 654 cases per 100,000 person years, compared to the highest CDC estimated US incidence, (p< 0.0001).
Discussion: We found that LA in patients is associated with an over twenty fold increased incidence of IBD, and may be an early sign of the disease. Some IBD therapies may be reasonable in select patients with isolated LA, and clinicians should not be hesitant to repeat colonoscopy in those with isolated LA and ongoing complaints.
Citation: Aurada Cholapranee, MD, Keith Sultan, MD, Charles J. Pohanka, IV, BA. P0469 - ISOLATED LYMPHOID AGGREGATES IDENTIFIED IN NON-INFLAMMATORY BOWEL DISEASE (IBD) PATIENTS ARE ASSOCIATED WITH AN INCREASED INCIDENCE OF IBD DEVELOPMENT. Program No. P0469. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.