NEW ORLEANS (EGMN) – Patients with irritable bowel disease are significantly more likely than the general population to develop pancreatic cancer, according to the first prospective study to assess standardized incidence rates of both disorders.

Men with ulcerative colitis are at a particularly high risk – more than 6 times as likely to develop pancreatic cancer as are men without ulcerative colitis, Dr. Jason Schwartz said May 3 at the annual Digestive Disease Week.

If the data are confirmed in larger studies, they may justify population-based screening for patients with either ulcerative colitis or Crohn’s disease – particularly men. “It’s too early right now to make screening recommendations, but providers should keep in mind that males with ulcerative colitis may harbor an inclination to develop pancreatic cancer,” said Dr. Schwartz of the University of Utah, Salt Lake City. “Perhaps in the future, this study may open the door to screening for pancreatic cancer in patients with irritable bowel disease, similar to what we now do for patients with IBD who have an increased risk of colon cancer.”

Dr. Schwartz and his colleagues extracted 10-year data on irritable bowel disease and pancreatic cancer cases in Utah from the University of Utah Health Care system and the Utah Cancer Registry.

From 1996 to 2006, there were 2,877 adult cases of irritable disease in the database. The investigators then matched these cases to pancreatic cancer cases in the cancer registry and the Utah population database. “What we found was striking and unexpected,” Dr. Schwartz said. “We felt there would be an association, but we were surprised by the strength of it.”

The investigators found 12 cases with both IBD and pancreatic cancer. Even after excluding five cases – because the cancer was diagnosed before the IBD – the association remained strong. “The expected rate of pancreatic cancer in Utah is 4/100,000 person-years,” Dr. Schwartz said. “The association that we saw worked out to be 7/15,000 person-years.”

All of these cases occurred in men with ulcerative colitis. So while the overall risk for pancreatic cancer in any patient with either ulcerative colitis or Crohn’s disease was 3.4, men with ulcerative colitis were 6.22 times more likely to develop the cancer than were men without ulcerative colitis.

The pathologic connection between IBD and pancreatic cancer has not been fully explored. However, repeated bouts of inflammation probably are involved, he said. “The intestines also become more permeable and allow bacteria to come into contact with the pancreas and liver,” which may contribute to the process, Dr. Schwartz said.

He had no financial disclosures relevant to the study.

Copyright (c) 2009 Elsevier Global Medical News. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

新奥尔良(EGMN)——根据评价炎症性肠病(IBD)和胰腺癌标准化发生率的首项前瞻性研究，炎症性肠病患者发生胰腺癌的几率显著高于普通人群。

 

Jason Schwartz博士在5月3日召开的本年度消化疾病周(Digestive Disease Week)会议上说，男性溃疡性结肠炎患者为极高危人群，其胰腺癌的发生几率较无溃疡性结肠炎的男性高6倍以上。

 

若此数据在较大规模的研究中得以证实，则可以此推荐对溃疡性结肠炎或克罗恩病患者(特别是男性)进行筛查。“目前提出筛查建议尚为时过早，但医护人员应谨记男性溃疡性结肠炎患者可能有发生胰腺癌的倾向，”盐湖城犹他大学Schwartz博士指出。“也许将来该研究可能会开启对炎症性肠病患者筛查胰腺癌的新篇章，这与我们现在对结肠癌风险较高的IBD患者的做法相近。”

 

Schwartz博士及其同事从犹他大学卫生保健系统和犹他癌症注册处抽取了10年有关炎症性肠病及胰腺癌病例的数据。

 

1996~2006年间，数据库中共2,877例成年炎症性肠病患者。研究者将这些病例与癌症注册处的胰腺癌病例相匹配。“我们的结果令人震惊且出乎意料，”Schwartz博士说。“我们感觉可能存在相关性，但我们还是对这种相关性的强度深感意外。”

 

研究者发现了12例同时患有IBD和胰腺癌的患者。即使排除5例胰腺癌诊断早于IBD的患者，仍存在很强的相关性。“犹他州胰腺癌预测发病率为4例/100,000人年，”Schwartz博士说。“我们所观察到的相关性达到7例/15,000人年。”

 

所有这些病例均发生于男性溃疡性结肠炎患者。无论是溃疡性结肠炎患者抑或克罗恩病患者，其胰腺癌总发病风险均为3.4，而男性溃疡性结肠炎患者发生胰腺癌的几率较无溃疡性结肠炎的男性高6.22倍。

 

IBD与胰腺癌之间的病理学关系尚未得到充分探讨，但这可能与反复的验证炎症刺激有关，他说。“同时，肠道渗透性增加，使细菌得以进入胰腺和肝脏，”这可能诱发了此病程，Schwartz博士说。

 

Schwartz博士没有与本研究相关的经济利益披露。

 

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