Inflamm Bowel Dis. 2021 Jul 10;izab164. doi: 10.1093/ibd/izab164. Online ahead of print.

Simcha Weissman ¹, Hannah K Systrom ², Muhammad Aziz ³, Mohammed El-Dallal ^2 4, Wade Lee-Smith ⁵, Michael Sciarra ⁶, Joseph D Feuerstein ⁷

Author information

• ¹Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, New Jersey, USA.
• ²Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
• ³Division of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, OH, USA.
• ⁴Division of Hospital Medicine, Cambridge Health Alliance, Cambridge and Harvard Medical School, MA, USA.
• ⁵Department of Library Sciences, University of Toledo Medical Center, Toledo, OH, USA.
• ⁶Division of Gastroenterology and Hepatology, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA.
• ⁷Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.

Abstract

Background: Owing to the increased risk of colorectal cancer (CRC) in patients with inflammatory bowel disease (IBD), numerous societies developed preventative guidelines. We aimed to assess the overall quality of CRC prevention guidelines in IBD.

Methods: A systematic search was performed in multiple databases to identify all guidelines pertaining to CRC prevention in IBD in September 2020. All guidelines were reviewed for conflicts of interest (COIs)/funding, recommendation quality/strength, external guideline review, use of patient representation, and plans for update-as per Institute of Medicine standards. In addition, recommendations were compared amongst societies.

Results: One hundred forty-nine recommendations from 14 different guidelines/societies were included. Not all guidelines provided recommendations on key elements surrounding (1) screening initiation and surveillance, (2) screening modality, (3) pharmacological chemoprevention, (4) dysplasia management and follow-up, and (5) molecular marker use. Only 71% of guidelines disclosed COIs, 43% reported industry funding, 14% were externally reviewed, 7% included patient representation, and 36% had plans for update. Of the total recommendations, 7.4%, 23.5%, and 69.1% were based on high,- moderate-, and low-quality evidence, respectively. Additionally, 20.1% of recommendations were strong, 14.1%, were weak/conditional, and 65.8% did not provide a strength. The proportion of high-quality evidence (P = 0.34) and strong recommendations (P = 0.57) did not significantly differ across societies.

Conclusions: Many guidelines do not provide recommendations on key aspects of CRC prevention in IBD. Over 90% of recommendations are based on low- to moderate-quality evidence; therefore, further studies on CRC prevention in IBD are needed to improve the overall quality of evidence.