ORIGINAL ARTICLE Small Bowel Adenocarcinoma in Patients with Crohn’s Disease Compared with Small Bowel Adenocarcinoma De Novo Vanessa Palascak-Juif,* Anne Marie Bouvier,† Jacques Cosnes,‡ Bernard Flourie ´,§ Olivier Bouche ´, k Guillaume Cadiot, k Marc Le ´mann,¶ Bruno Bonaz,** Christine Denet,†† Philippe Marteau,‡‡ Luc Gambiez,§§ Laurent Beaugerie,‡ Jean Faivre,† and Franck Carbonnel* Background: Data concerning small bowel adenocarcinoma (SBA) in Crohn’s disease (CD) come from case reports and small retro- spective series. The aim of this study was to further describe SBA in patients with CD and compare it with SBA de novo. Methods: Twenty patients with CD with SBA recruited in French university hospitals were studied and compared with 40 patients with SBA de novo recruited from a population-based registry. SBA oc- curred after a median time of 15 years of CD and was located within the inflamed areas of the ileum (n = 19) or jejunum (n = 1), whereas in patients with SBA de novo, it was distributed all along the small intestine. Median age at diagnosis of SBA was 47 years (range, 33– 72 yr) in patients with CD and 68 years (range, 41–95 yr) in those with SBA de novo. Results: The cumulative risk of SBA, assessed in a subgroup of pa- tients, was 0.2% and 2.2% after 10 and 25 years of ileal CD, respec- tively. SBA accounted for 25% and 45% of the risk of gastrointestinal carcinoma after 10 and 25 years of CD, respectively. Diagnosis was made preoperatively in 1/20 patients with CD and 22/40 patients with SBA de novo. Signet ring cells were found in 35% of patients with CD but not in patients with SBA de novo. Relative survival was not significantly different in these 2 categories of patients (54 versus 37% and 35 versus 30% in patients with and without CD at 2 and 5 yr, respectively). Conclusions: SBA in CD is different from SBA de novo. It arises from longstanding ileal inflammation and is difficult to diagnose. SBA cumulative risk increases after 10 years of CD and is likely to cause premature mortality in patients with early-onset CD. Key Words: Crohn’s disease, inflammatory bowel disease, small bowel adenocarcinoma (Inflamm Bowel Dis 2005;11:828–832) P atients with Crohn’s disease (CD) have an increased risk of small bowel adenocarcinoma (SBA). 1–4 Data concerning SBA in CD are few, and the cumulative risk is still unknown. A myriad risk factors for SBA have been suggested in patients with CD: jejunal location, male sex, small bowel bypass sur- gery, occupational hazards, long duration of CD, and azathi- oprine use. 5–7 Furthermore, it has also been suggested that SBA in patients with CD develops at a younger age 8 and car- ries a poorer prognosis than SBA de novo. 7–11 However, most information concerning SBA in CD is based on case reports, small retrospective series, and literature reviews, 5–13 and there has been no direct comparison between SBA in CD and de novo. The purpose of this study was to examine these issues on a larger scale than that of previous studies. The characteristics of SBA in patients with CD were studied and compared with those of SBA de novo recruited from a population-based registry. MATERIALS AND METHODS Patients Two groups of patients were studied. Group 1 was comprised of patients with SBA and CD from the centers affiliated with the Groupe d’Etude The ´rapeutique des Affections Inflammatoires Digestives (GETAID). GETAID is a French-speaking association of gastroenterologists that coordinates multicenter clinical research in the field of in- flammatory bowel disease. Centers affiliated with GETAID are located in university hospitals of Belgium, France, and Switzerland. They were asked to collect data on patients who had SBA and CD between 1986 and 2003. Informations collected about CD included date of first symptoms and Received for publication June 1, 2005; accepted June 3, 2005. From the *Services de Gastroente ´rologie, CHU de Besanc xon; ‡Paris-Saint Antoine; §Lyon Sud; k Reims; {Paris-Saint Louis; **Grenoble; ††Paris-Institut Mutualiste Montsouris; ‡‡Paris-Ho ˆpital Europe ´en Georges Pompidou; §§Service de Chirurgie Digestive, CHU de Lille; and †Registre des cancers digestifs de Bourgogne, Dijon. France. Reprints: Franck Carbonnel, Service de Gastroente ´rologie et Nutrition, CHU Jean Minjoz, 25000 Besanc xon, France (e-mail: fcarbonnel@chu-besancon.fr) Copyright Ó 2005 by Lippincott Williams & Wilkins 828 Inflamm Bowel Dis  Volume 11, Number 9, September 2005