Trends in Colorectal Dysplasia in Patients With IBD
Diseases of the Colon and Rectum, 2026
John J Newland, Joel Grunhut, Rachael Belcher, Kerri E Lopez, Rebecca F Brown, Samuel Eisenstein, Andrea C Bafford
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In brief
Using the ACS NSQIP IBD Collaborative (2017 to 2023), we studied 5,516 adults with inflammatory bowel disease who had colorectal surgery, to measure how often dysplasia turned up on surgical pathology and which patients were at highest risk.
Key findings
Dysplasia (low-grade, high-grade or carcinoma) was found in 4.3% of 5,516 surgical IBD patients.
On multivariable analysis, immunotherapy use (OR 1.6), ulcerative colitis (OR 2.0) and Asian American race (OR 2.54) were independently associated with dysplasia.
The findings support tailored surveillance for at-risk IBD patients, particularly those on long-term immunosuppressive therapy.
Abstract
BACKGROUND: Patients with IBD face an elevated risk for early-onset colorectal cancer due to chronic inflammation and long-term immunosuppression. Although immunotherapy improves disease control, its potential for increasing neoplastic transformation warrants further evaluation. OBJECTIVE: To characterize trends in incidence and clinical factors associated with dysplasia among patients with IBD undergoing surgery. DESIGN: This is a retrospective cohort study. SETTING: High-volume US IBD centers participating in the American College of Surgeons National Surgery Quality Improvement Program IBD Collaborative, 2017 to 2023. PATIENTS: Adults with IBD undergoing colorectal surgery. Patients with missing covariate or outcome data were excluded. MAIN OUTCOME MEASURES: Prevalence of dysplasia (low-grade, high-grade, or carcinoma) on surgical pathology and associated risk factors. RESULTS: Among 5516 patients with IBD, dysplasia was identified in 4.3%. Prevalence was higher in patients with ulcerative colitis compared to those with Crohn's disease and indeterminate colitis (6.5% vs 3.2% vs 3.4%, respectively, p < 0.05), in those receiving immunotherapy (16.7% vs 12.0%, p = 0.02), and among Asian American patients (8.7% vs 4.5% White and 2.4% Black, p < 0.05). Female sex and older age (mean 53.9 vs 43.1 years) were also associated with increased dysplasia rates ( p < 0.05). On multivariable logistic regression analysis, Asian American race (OR 2.54 [95% CI, 1.4-4.8]), immunotherapy use (OR 1.6 [95% CI, 1.1-2.3]), and ulcerative colitis (OR 2.0 [95% CI, 1.6-2.7]) were independently associated with dysplasia. A BMI of <18.5 was inversely associated with risk (OR 0.4 [95% CI, 0.2-0.9]). LIMITATIONS: Data capture is limited to 30 days postoperatively and does not account for surgical indication or dysplasia chronicity. CONCLUSIONS: In patients undergoing surgery for IBD, immunotherapy use, Asian American race, ulcerative colitis, and older age were independently associated with colorectal dysplasia. These findings highlight the importance of tailored surveillance strategies in at-risk populations, particularly those receiving long-term immunosuppressive therapy.
How to cite
Newland JJ, Grunhut J, Belcher R, Lopez KE, Brown RF, Eisenstein S, et al. Trends in Colorectal Dysplasia in Patients With IBD. Dis Colon Rectum. 2026;69(8):2074-2082. doi:10.1097/DCR.0000000000004289