Radiation Exposure in Patients with Inflammatory Bowel Disease: a Fourteen-Year Review at a Tertiary Care Centre in Malaysia

Document Type: Research Articles

Authors

1 Gastroenterology Unit, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.

2 Department of Radiology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.

3 Department of Physiology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.

Abstract

Background and Aims: Patients with inflammatory bowel disease (IBD) are subjected to a large amount of ionizing
radiation during the course of their illness. This may increase their risk of malignancy to a greater level than that due
to the disease itself. In Caucasian patients with Crohn’s disease, this has been well documented and recommendations
are in place to avoid high radiation imaging protocols. However, there are limited data available on radiation exposure
in Asian IBD patients.We therefore sought to identify total radiation exposure and any differences between ethnically
diverse ulcerative colitis (UC) and Crohn’s disease (CD) patients at our centre along with determining factors that may
contribute to any variation. Methods: The cumulative effective dose (CED) was calculated retrospectively from 2000
to 2014 using data from our online radiology database and patients’ medical records. Total CED in the IBD population
was measured. High exposure was defined as a radiation dose of greater than 0.2mSv (equivalent to slightly less than
½ a year of background radiation). Results: A total of 112 cases of IBD (36 CD and 76 UC) were reviewed. Our CD
patients were diagnosed at an earlier age than our UC cases (mean age 26.1 vs 45.7). The total CED in our IBD population
was 8.53 (95% CI: 4.53-12.52). Patients with CD were exposed to significantly higher radiation compared to those
with UC. The mean CED was 18.6 (7.30-29.87) and 3.65 (1.74-5.56, p=0.01) for CD and UC patients respectively. 2
patients were diagnosed as having a malignancy during follow up with respective CED values of 1.76mSv and 10mSv.
Conclusions: CD patients, particularly those with complicated disease, received a higher frequency of diagnostic
imaging over a shorter period when compared to UC patients. Usage of low radiation imaging protocols should be
encouraged in IBD patients to reduce their risk of consequent malignancy.

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