Description
This logic path provides colorectal cancer screening recommendations for individuals with inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis.
Mid-Level Flow Diagram
Semi-Structured Logic Statements
Inclusions
| Name | Description |
|---|---|
Patients with a personal history of inflammatory bowel disease | Patients with a personal history of inflammatory bowel disease (ulcerative colitis or Crohn's disease) |
Exclusions
None.
Events
| Name | Description |
|---|---|
Primary Sclerosing Cholangitis? | |
CONDITIONS include `Primary Sclerosing Cholangitis` | |
Indeterminate or microscopic colitis? | |
CONDITIONS include `Indeterminate Colitis` with status active OR CONDITIONS include `Microscopic Colitis` with status active | |
Actions
Recommendation: initial colonoscopy at PSC diagnosis and surveillance colonoscopy every year Description RECOMMENDATION: * Initial screening colonoscopy: at the time of PSC diagnosis. * Surveillance interval: colonoscopy every year. Source: AGA, 2021; ACG, 2015; ACG, 2018; ACG, 2019 Pseudocode |
Patients not at increased risk for colorectal cancer Description Patients with microscopic or indeterminate colitis are not at increased risk for colorectal cancer. Pseudocode |
Recommendation: Initial colonoscopy 8-10 years after disease onset and surveillance colonoscopy every 1-5 years Description RECOMMENDATION: * Initial screening colonoscopy: 8-10 years after disease onset. * Modality and interval: colonoscopy every 1-5 years based on a recommendation from GI specialist. Considerations: * These recommendations do not apply to patients with Crohn's disease without colonic involvement. Source: AGA, 2021; ASGE, 2015; ACG, 2019; ACG, 2018 Pseudocode |
References
- AGA (2021): Murthy, S. K., et al. (2021). AGA Clinical Practice Update on Endoscopic Surveillance and Management of Colorectal Dysplasia in Inflammatory Bowel Diseases: Expert Review. Gastroenterology, 161(3), 1043-1051.e4. https://doi.org/10.1053/j.gastro.2021.05.063
- ACG (2015): Lindor, K. D., et al. (2015). ACG Clinical Guideline: Primary Sclerosing Cholangitis. American Journal of Gastroenterology, 110(5), 646-659. https://doi.org/10.1038/ajg.2015.112
- ACG (2018): Lichtenstein, G.R., et al. (2018). ACG Clinical Guideline: Management of Crohn’s Disease in Adults. American Journal of Gastroenterology, 113(4), 481-517. https://doi.org/10.1038/ajg.2018.27
- ACG (2019): Rubin, D. T., et al. (2019). ACG Clinical Guideline: Ulcerative Colitis in Adults. The American journal of gastroenterology, 114(3), 384–413. https://doi.org/10.14309/ajg.0000000000000152
- ASGE (2015): Shergill, A.K., et al. (2015). The role of endoscopy in inflammatory bowel disease, Gastrointestinal Endoscopy, 81(5), 1101-1121.e13. https://doi.org/10.1016/j.gie.2014.10.030