Long-standing inflammatory bowel disease (IBD) with colonic involvement — either ulcerati...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

ID	`RF-IBD-CRC-PREVENTION`
Type	Red flag
Status	reviewed 2026-05-18 \| pending_clinical_signoff
Diseases	`DIS-CRC`
Sources	`SRC-ESMO-COLON-2024` `SRC-ESMO-CRC-2024` `SRC-NCCN-COLON-2025`

Red Flag Origin

Definition	Long-standing inflammatory bowel disease (IBD) with colonic involvement — either ulcerative colitis (UC) with diagnosis ≥8 years, or Crohn's colitis (involvement of ≥1/3 of colon) with diagnosis ≥8 years, or IBD with concomitant primary sclerosing cholangitis (PSC) regardless of duration (PSC-IBD is the highest-risk IBD subgroup for colorectal cancer — cumulative CRC risk ~15-30% at 30 years from PSC diagnosis). No current colorectal cancer diagnosis. Chronic colonic inflammation drives colitis-associated dysplasia and CRC via an inflammation-dysplasia-carcinoma sequence distinct from sporadic CRC (often arises from flat dysplasia, multifocal, harder to detect by conventional white-light colonoscopy). Surveillance colonoscopy with chromoendoscopy or high-definition white-light reduces CRC mortality in this population. Prevention-persona RedFlag (§20 ratification 2026-05-18, v0.3 chronic...
Clinical direction	investigate
Category	other

Trigger Logic

{
  "any_of": [
    {
      "finding": "inflammatory_bowel_disease_uc_diagnosis_ge_8y",
      "value": true
    },
    {
      "finding": "inflammatory_bowel_disease_crohn_colitis_ge_8y",
      "value": true
    },
    {
      "finding": "inflammatory_bowel_disease_with_primary_sclerosing_cholangitis",
      "value": true
    }
  ],
  "type": "lab_value"
}

Notes

v0.3 chronic-condition prevention pilot — IBD-associated CRC. Prevention-persona RedFlag (CHARTER §3 amended 2026-05-18 Path A, HCP-mediated). Fires when patient profile shows long-standing IBD with colonic involvement AND no confirmed CRC. Engine routes to PreventionPlan with 2 tracks: surveillance colonoscopy with chromoendoscopy q1-2y per AGA/ECCO/NCCN (IND-IBD-CRC-PREVENTION-CHROMOENDOSCOPY) as standard; routine q3-5y colonoscopy (IND-IBD-CRC-PREVENTION-OBSERVATION) as alternative — clinically below standard-of-care but included per §15.2 C4 and CHARTER §11 patient-autonomy framing. Evidence base: - **AGA Clinical Practice Update on Surveillance and Management of Dysplasia in IBD (2021):** Chromoendoscopy with targeted biopsies preferred over white-light random biopsies. q1-3y surveillance from 8-10y after IBD diagnosis (extension of colitis matters more than duration), or from PSC diagnosis in PSC-IBD. - **ECCO Guideline on IBD-associated CRC (2024):** Aligns with AGA; additionally recommends high-definition white-light + virtual chromoendoscopy (NBI, BLI) as alternative to dye-spray when chromoendoscopy not available. - **CRC risk in UC (Eaden meta-analysis JAMA 2001 + updat...

Used By

Indications

IND-IBD-CRC-PREVENTION-CHROMOENDOSCOPY - IND-IBD-CRC-PREVENTION-CHROMOENDOSCOPY
IND-IBD-CRC-PREVENTION-OBSERVATION - IND-IBD-CRC-PREVENTION-OBSERVATION