This proposal will attempt to clarify issues of cancer prevention in ulcerative colitis (UC). Colorectal cancer (CRC) is the most ominous long-term complication of UC. To reduce mortality from CRC, most clinicians employ a system of surveillance, in which periodic colonoscopies are performed with multiple biopsies sent for histologic review. In this paradigm, patients found to have dysplasia or CRC are referred for surgery and patients free of dysplasia continue with surveillance examinations. Unfortunately, no published report demonstrates a mortality benefit for surveillance, but the lack of appeal for prophylactic colectomy or waiting for a symptomatic cancer to arise has led to near universal acceptance of this unproven practice. In an effort to better define high- and low-risk populations with longstanding UC, and to therefore improve upon the current practice of surveillance, the proposed project will assess surveillance, assessing the effect of long durations of dysplasia-free disease, use of anti-inflammatory medications, and the influence of colonic inflammation on the development of dysplasia or CRC.
In Aim 1, key features of surveillance will be examined: sub-Aim 1 will assess whether duration of disease influence the rate of neoplastic development for a group of patients under surveillance;sub-Aim 2 will address the question of colonoscopy frequency for patients under surveillance;and sub-Aim 3 will attempt to determine the effect of """"""""under-sampling,"""""""" in which an inadequate number of biopsies are performed at surveillance.
Aim 2 will address the important question of chemoprevention, looking at the effect of anti-inflammatory medications on the development of dysplasia and cancer. And finally, Aim 3 will examine the influence of colonic inflammation at surveillance on the subsequent development of colonic neoplasia. All of these studies will be performed by development and subsequent query of a large database that already holds the clinical, endoscopic, and histopathologic histories of over 500 patients with UC at a large, tertiary care center.

Agency
National Institute of Health (NIH)
Institute
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type
Clinical Investigator Award (CIA) (K08)
Project #
5K08DK069393-05
Application #
7673453
Study Section
Diabetes, Endocrinology and Metabolic Diseases B Subcommittee (DDK)
Program Officer
Podskalny, Judith M,
Project Start
2005-09-15
Project End
2010-08-31
Budget Start
2009-09-01
Budget End
2010-08-31
Support Year
5
Fiscal Year
2009
Total Cost
$128,654
Indirect Cost
Name
Icahn School of Medicine at Mount Sinai
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
078861598
City
New York
State
NY
Country
United States
Zip Code
10029
Lazarev, Mark; Present, Daniel H; Lichtiger, Simon et al. (2012) The effect of intravenous cyclosporine on rates of colonic surgery in hospitalized patients with severe Crohn's colitis. J Clin Gastroenterol 46:764-7
Goldstone, Robert; Itzkowitz, Steven; Harpaz, Noam et al. (2012) Dysplasia is more common in the distal than proximal colon in ulcerative colitis surveillance. Inflamm Bowel Dis 18:832-7
Trindade, Arvind J; Morisky, Donald E; Ehrlich, Adam C et al. (2011) Current practice and perception of screening for medication adherence in inflammatory bowel disease. J Clin Gastroenterol 45:878-82
Ullman, Thomas A; Itzkowitz, Steven H (2011) Intestinal inflammation and cancer. Gastroenterology 140:1807-16
Trindade, Arvind J; Ehrlich, Adam; Kornbluth, Asher et al. (2011) Are your patients taking their medicine? Validation of a new adherence scale in patients with inflammatory bowel disease and comparison with physician perception of adherence. Inflamm Bowel Dis 17:599-604
Goldstone, Robert; Itzkowitz, Steven; Harpaz, Noam et al. (2011) Progression of low-grade dysplasia in ulcerative colitis: effect of colonic location. Gastrointest Endosc 74:1087-93
Shah, Brijen; Tinsley, Andrew; Ullman, Thomas (2011) Quality of care in inflammatory bowel disease. Curr Gastroenterol Rep 13:87-94
Siegel, Corey A; Melmed, Gil Y; Ullman, Thomas A (2010) Improving quality of care in IBD: a STEEEP challenge. Inflamm Bowel Dis 16:134-6
Ullman, Thomas A (2010) Inflammatory bowel disease-associated cancers: does gender change incidence? Gastroenterology 138:1658-60
Hefti, Marco M; Chessin, David B; Harpaz, Noam H et al. (2009) Severity of inflammation as a predictor of colectomy in patients with chronic ulcerative colitis. Dis Colon Rectum 52:193-7

Showing the most recent 10 out of 13 publications