Precancerous colorectal lesions, or dysplasia, in patients with inflammatory bowel disease (IBD) confer markedly different risks of future colorectal cancer depending on dysplasia grade, according to a comprehensive registry study from Karolinska Institutet, Sweden, and NYU Grossman School of Medicine, New York, published in Clinical Gastroenterology and Hepatology.
The researchers analyzed more than 54,000 patients with inflammatory bowel disease (IBD) to provide the most comprehensive estimates to date of colorectal dysplasia progression and colorectal cancer risk across dysplasia subtype, as part of the nationwide ESPRESSO study . The results show that among patients with IBD without baseline dysplasia, only 2.3% developed advanced colorectal neoplasia (high-grade dysplasia or colorectal cancer) during follow-up. In contrast, 5.3% of patients with indefinite dysplasia and 8.3% of those with low-grade dysplasia progressed to advanced neoplasia. Strikingly, 40% of patients with high-grade dysplasia developed colorectal cancer, often within one year. The study addresses longstanding uncertainty around the natural history of IBD-associated dysplasia and provides robust, population-level risk estimates that directly inform clinical decision-making.
"Dysplasia in IBD is not a uniform entity and future colorectal cancer risk escalates substantially by grade, with high-grade lesions conferring an alarming short-term colorectal cancer risk" says by the study's first author Jordan Axelrad , MD, MPH, from the Division of Gastroenterology at NYU Grossman School of Medicine. "Our findings reinforce the need for timely, individualized surveillance and management strategies based on dysplastic findings."
"This study highlights the opportunities offered by the ESPRESSO cohort where we linked histopathology data - including information on dysplasia and cancer from 28 pathology departments, to the nationwide healthcare registers in Sweden" says the study's senior author Prof. Jonas F. Ludvigsson from the Department of Medical Epidemiology and Biostatistics , Karolinska Institutet and physician at the Örebro University Hospital.
The study was conducted in collaboration with researchers at Örebro University. The study was funded by Crohn's and Colitis Foundation, the Judith & Stewart Colton Center for Autoimmunity, the NIH NIDDK Diseases K23DK124570, NIA K76 AG083286, and the American College of Gastroenterology. All conflicts of interest are listed in the paper.
Publication
Axelrad J, Faye AS, Söderling J, Mårild K, Halfvarson J, Veress G, Olén O, Ludvigsson JF. Clinical Gastroenterology Hepatology, online February 16, 2026.
