High Prevalence of Anal Canal High-Risk Human Papillomavirus Infection in Patients With Crohn's Disease.

BACKGROUND & AIMS: The increasing incidence of anal canal carcinomas requires better knowledge on anal human papillomavirus (HPV) infection. We aimed to assess anal canal HPV infection prevalence and risk factors among patients seen at a gastroenterology department in France. METHODS: We analyzed anal tissue samples collected from 469 consecutive patients (median age 54 years, 52% women), including 112 who received immunosuppressant therapies and 101 with inflammatory bowel disease (70 with Crohn's disease), who underwent colonoscopy examinations from April 1, 2012 to April 30, 2015. HPV was detected and genotyped using the INNO-LiPA assay, and we collected medical and demographic data from all subjects. Risk factors for any HPV, high-risk HPV (HR-HPV) and HPV16 infection were assessed by bivariate and multivariate analysis. The primary outcomes association of HR-HPV or HPV16 with medical and demographic features. RESULTS: We detected HPV DNA in anal tissues from 34% of the subjects and HR-HPV in 18%. HPV16 was the most prevalent genotype (detected in 7%), followed by HPV51, HPV52, and HPV39. HR-HPV was detected in a significantly higher proportion of samples from women (23.1%) than men (12.8%) (P = .0035); HR-HPV and HPV16 were detected in a significantly higher proportion of patients with Crohn's disease (30.0%) than without (18.1%) (P = .005). Female sex, history of sexually transmitted disease, lifetime and past year-number of sexual partners, active smoking, and immunosuppressive therapies were independent risk factors for anal HR-HPV infection in multivariate analysis. CONCLUSION: One third of patients who underwent colonoscopy at a gastroenterology department were found to have anal canal HPV infection. We detected HR-HPV infection in almost 20% of patients and in a significantly higher proportion of patients with Crohn's disease than without. Increasing our knowledge of HPV infection of anal tissues could help physicians identify populations at risk and promote prophylaxis with vaccination and adequate screening.

[Management of anorectal bleeding]. / Conduite à tenir devant un saignement anorectal

Management of anorectal bleeding. Anorectal bleeding is a common reason for consultation in general medical practice. The ano-rectal origin is suspected on the characteristics of the bleeding which is often scant and bright red color. Medical history and clinical examination alone are often sufficient to make a diagnosis, since the main causes are hemorrhoids and anal fissure. On the other hand, the estimated risk of anorectal tumours in patients with ano-rectal bleeding has been reported in about 10%. Colonoscopy is therefore necessary at the slightest diagnostic doubt and, anyway, in all patients aged over 45 years.

Conduite à tenir devant un saignement anorectal. Les saignements anorectaux sont un motif de consultation fréquent en médecine générale. L'origine anorectale est suspectée sur les caractéristiques du saignement, qui est habituellement de faible abondance et de couleur rouge vif. L'interrogatoire et l'examen clinique seuls suffisent le plus souvent à poser un diagnostic étiologique, puisque les causes sont dominées par la pathologie hémorroïdaire et la fissure anale. D'un autre côté, la pathologie tumorale anorectale, hantise aussi bien des patients que des médecins, en est la cause dans environ 10 %. La coloscopie reste donc indiquée au moindre doute diagnostique et, de principe, chez tous les patients âgés de plus de 45 ans.