1 Division of Infectious Diseases, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania2 Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania3 University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania4 Alpha StatConsult, Damascus, Maryland5 Magee–Womens Research Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
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BACKGROUND:Defective cell-mediated immunity increases the risk of human papillomavirus–associated anal dysplasia and cancer. There is limited information on anal canal disease in patients with IBD.OBJECTIVE:The purpose of this study was to assess anal/vaginal human papillomavirus and anal dysplasia prevalence in patients with IBD.DESIGN:Patients had an anal examination before routine colonoscopy.SETTINGS:The study was conducted at a tertiary IBD referral center.PATIENTS:We studied a convenience sample of sexually active male and female patients with IBD who were not on biological therapy.INTERVENTION:Anal examination, anal and vaginal human papillomavirus testing, anal cytology, and high-resolution anoscopy/biopsy were carried out.MAIN OUTCOME MEASURES:Anal and vaginal human papillomavirus types, anal cytology, and biopsy grade were measured.RESULTS:Twenty-five male and 21 female evaluable participants, 31 with Crohn’s disease, 14 with ulcerative colitis, and 1 with indeterminate colitis, were predominantly white (91.3%), treatment experienced (76.1%), an average age of 38.1 years (range, 22.0–66.0 y), and had an average length of IBD diagnosis of 9.3 years (range, 1.0–33.0 y). Eighteen (39.1%) had an abnormal perianal examination and 3 (6.5%) had an abnormal digital examination. Forty-one (89.1%) had anal human papillomavirus, 16 with a single type and 25 with multiple types (range, 2–5 types). Human papillomavirus type 16 was most common (65.2%), followed by human papillomavirus types 11 and 45 (37.0% each). Nineteen of 21 (90.5%) women had vaginal human papillomavirus. Overall, 21 (45.7%) had abnormal anal cytology. Thirty three (71.7%) had ≥1 anal biopsy (9 had multiple), with dysplasia diagnosed in 28 (60.9%) and high-grade and low-grade squamous intraepithelial lesions diagnosed in 4 (8.7%) and 24 (43.5%).LIMITATIONS:No control group was included, and no detailed sexual history was taken.CONCLUSIONS:A high prevalence of anal and vaginal human papillomavirus and anal dysplasia was demonstrated in the study population outcomes. See Video Abstract at http://links.lww.com/DCR/A379.