Abnormal Pap smears more likely in women with inflammatory bowel disease

Last Updated: 2008-04-04 14:23:03 -0400 (Reuters Health)

By Will Boggs, MD

NEW YORK (Reuters Health) - Women with inflammatory bowel disease (IBD), especially those treated with immunosuppressants, are more likely than healthy controls to have abnormal Pap smears, according to a report in the March issue of the American Journal of Gastroenterology.

"Be thoughtful about all the consequences of chronic immunosuppression," Dr. Sunanda Kane from the Mayo Clinic, Rochester, Minnesota told Reuters Health. "These women have a diminished ability to fight off HPV (human papillomavirus)."

Dr. Kane and colleagues compared the incidence of cervical abnormalities in 40 women with IBD (for whom 134 Pap smears were available) and in matched controls with documented Pap smears.

Women with a history of IBD were 4.3 times more likely than healthy controls to have an abnormal Pap smear, the investigators report. Frequencies of all cervical abnormalities were higher among IBD patients, but no cervical cancers were found in either group.

IBD patients exposed to immunomodulators were 4.5 times more likely than controls and 1.9 times more likely than nonexposed IBD patients to have higher risk abnormalities, the researchers note, "although the number of nonexposed patients was small."

Pap smears performed on women receiving multiple immunosuppressants were more likely to be abnormal than normal, the investigators say, and there was a trend for more Pap smears to be abnormal with an exposure to immunosuppressants exceeding 6 months compared with less than 6 months.

Other factors, including smoking, family history, and sexual history, could not account for the significant differences in abnormal Pap smears between IBD patients and controls.

"Whether this risk is due to altered immunity or other factors has yet to be clarified," the authors conclude. "The addition of immune suppressants increases this risk further, and these patients should be screened as higher risk per the ACOG guidelines."

Physicians should "recommend the HPV vaccine to all women with IBD who are appropriate candidates, and certainly those who are on immunomodulators," Dr. Kane said.

Am J Gastroenterol 2008;103:631-636.