Colorectal cancer (CRC) is a serious complication of inflammatory bowel disease (IBD). 5-aminosalicylic acid (5-ASA) is commonly used in the treatment of IBD and may have chemopreventative effects against CRC. The chemoprophylatic use of 5-ASA in IBD is debatable, but the theoretical basis for a protective role for 5-ASA is sound: chronic inflammation exposes patients to inflammatory mediators of tumour development. There is considerable evidence for the efficacy of 5-ASA in mild to moderate ulcerative colitis (UC). The benefits of 5-ASA in Crohn’s disease (CD) are less clear; a recent meta-analysis showed no benefit. The European Crohn’s and Colitis Organisation (ECCO) recommend its use for prevention of CRC in UC but have not addressed its use in CD. Assessment of its potentially protective effect against CRC relies on observational studies, since logistical and ethical constraints make a randomised controlled trial impossible. However, studies have had limitations and have yielded conflicting results. Further robust observational studies are required to provide a definitive answer to this question. Despite possible cost constraints, the favourable long-term safety profile of 5-ASA justifies its chemoprophylactic use in patients with risk factors for CRC.
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