b'Early Colonoscopy in Veterans With IBD Lowers Overall MortalityWell-timed colonoscopy appears to improve overall survival in inflammatory bowel disease patients, but many VA patients arent getting screened regularly. A new study supported current VA practice guidelines that recommend colonoscopy intervals from one year to three years among patients with IBD who have extensive colitis or left-sided colitis.By Annette M. BoyleHOUSTONBecause inflammatory bowel diseasechallenging,particularlywithoutcompellingevi-(IBD) significantly increases the risk of colorectaldence. To gain greater clarity on the best interval cancer (CRC), guidelines recommend that patientsfor veterans with IBD, researchers at the Michael E. withCrohnsdiseaseorulcerativecolitisreceiveDeBakey VAMC in Houston and the VA Ann Arbor, colonoscopiesmorefrequentlythantheevery10MI,HealthcareSystem,alongwithcolleagues years recommended for individuals over age 50 withacross the country, conducted a retrospective cohort normal risk of CRC. study of 566 veterans with confirmed CRC within a But just how frequently and how much benefit therecohort of 77,824 patients with IBD. The study used is to surveillance colonoscopy has remained murky15 years worth of data from the VHA.due to the lack of randomized controlled trialsandOf the 566, 358 had underlying ulcerative colitis, the ethical issues with attempting one. 195 had Crohns disease, and 13 had unclassified IBD. Finding the right interval is a matter of significanceThe average age of IBD diagnosis was 53.6 years and to the VA, as the agency diagnoses about 4,000 newthe mean age of CRC diagnosis was 67.5 years. 1cases of colorectal cancer each year. That makes itThe team compared multiple intervals between last the third-most-diagnosed malignancy in the nationscolonoscopy before CRC diagnosis, excluding any largest healthcare system.within six months of diagnosis: none, annual (six The VA does an extraordinary job of getting vet- months to a year), within one to three years, and erans screened, Folosade May, MD, staff gastro- within three to five years, with the intervals set based enterologistatthe WestLos Angeles VAMCtoldon those recommended by various professional soci-U.S. Medicine previously. While 1 in 3 Americanseties. More than five years was considered none. remainsunscreened,82%to84%ofveteransareas all guidelines advise screening this population at current on their screening today.least every five years.The American Gastroenterology Association notes that the optimal surveillance interval has not beenMost Had No Colonoscopyclearly defined. After two negative examinations (noNearly70%oftheveteranshadnotreceivedadysplasia or cancer), further surveillance examina- colonoscopy within five years of their CRC diagno-tions should be performed every one to three years.ses, while 9.7% had received one within the year, Othersocietyguidelinesrecommendintervals17.7% within one to three years, and 3.1% within between one and five years. Increased surveillancethree to five years. Those who had no colonoscopy colonoscopyisnotrecommendedforindividualsgenerally had not been diagnosed with IBD as long with isolated ileal or rectal disease. as veterans who were screened within one to five Frequentcolonoscopiesareunpleasantatbest,years, with mean duration of IBD of 12.4 years com-which makes convincing patients to undergo thempared to 15.7 to 17.7 years, respectively.Continued on Page 105 u97'