IBD-Related Colon Dysplasia Less Prevalent In Hispanic Vs Non-Hispanic White Patients

The prevalence of colon dysplasia related to inflammatory bowel disease (IBD) appears significantly lower among Hispanic patients than among non-Hispanic whites, even when similar risk factors are present, a new study suggests.

Researchers examined data on 445 IBD patients who were identified as Hispanic (n=148) or non-Hispanic white (n=297), were under surveillance for colorectal cancer, and treated at IBD or GI clinics in Miami, Florida, between 2008 and 2018. All the patients had an IBD diagnosis confirmed by standard methods such as endoscopy, imaging, histologic and surgical findings, as well as colonoscopy biopsies sent to the same academic pathologists.

Hispanic patients had a significantly lower prevalence of IBD-related colon dysplasia than non-Hispanic whites (adjusted odds ratio 0.21) after adjusting for disease duration, primary sclerosing cholangitis, family history of colon cancer, and smoking, researchers report in Crohn's & Colitis 360.

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"This is a surprising study since until now, IBD-related dysplasia has not been viewed as being different based on ethnicity," said Dr. Joseph Feuerstein of the Center for Inflammatory Bowel Disease at Beth Israel Deaconess Medical Center in Boston.

The results suggest that there may be differences based on the underlying genetics or underlying environmental exposures, Dr. Feuerstein, who wasn't involved in the study, said by email.

Three (2.02%) Hispanic patients had IBD-related colon dysplasia after a mean follow-up period of 1.73 years, compared with 29 (9.76%) non-Hispanic white patients after a mean follow-up period of 1.39 years.

Most of the Hispanic patients in the study were born in Cuba (28.9%) or had parents born in Cuba (36%). Many of the remaining Hispanic patients were born in Colombia (6.7%), Puerto Rico (3.8%), or one of 16 other countries. Most of the non-Hispanic white patients were born in the U.S. (78.2%).

One limitation of this cross-sectional analysis is that researchers were unable to assess the time from IBD onset to dysplasia, the study team notes. Researchers also relied on lifestyle questionnaires to identify certain risk factors such as smoking and alcohol use, and this makes the results subject to recall bias.

Lead author Dr. Damas Oriana of the University of Miami Miller School of Medicine didn't respond to requests for comment.

"While additional studies are needed to evaluate risk of IBD-related colon dysplasia and colorectal cancer in Hispanic patients, it is well established that, compared to non-Hispanic whites, Hispanics and other ethnic groups have negative social determinants of health which may adversely affect patients' ability to receive high-quality health care," said Dr. Nghia Nguyen, a gastroenterology/IBD fellow at University of California San Diego Health.

"These patients should be screened for social determinants of health such as lack of social support, food insecurity, financial toxicity, etc. to identify potential barriers to receiving guideline-recommended management, especially with IBD-dysplasia and colorectal cancer," Dr. Nguyen, who wasn't involved in the study, said by email.

—Lisa Rapaport

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