The potential development of colorectal carcinoma (CRC) as a complication of either ulcerative colitis (UC) or Crohn's disease (CD) is well recognised [1]. Patients with UC have a lifetime risk, between 6-10 times that of the general population of developing CRC, whereas patients with CD develop an increased life-time risk when more than 30% of the colon has become involved [2]. The development of neoplasia, in the form of either colonic epithelial dysplasia or adenocarcinoma, appears to be related to factors such as the severity and duration of the illness, the extent of colonic involvement and the overall responsiveness to medical intervention [3, 4]. Patients at higher risk are those with UC, extensive colitis, those with disease duration of more than 10 years, those with primary sclerosing cholangitis and patients with an early age of onset of colitis [5,6]. The risk of developing CRC as a result of longstanding CD is less than the risk faced by patients with UC in which, regardless of the extent of the colitis, the latter has been estimated as a 2% risk at 10 years, 8% at 20 years and 18% at 30 years [7]. It is assumed that CRC in patients with inflammatory bowel disease (IBD) develops, in most instances, in the background of colonic epithelial dysplasia.

This chapter looks briefly into the various definitions and classifications, pathological observations, genetic changes, types and validity of various surveillance programmes and treatment options of dyspla-sia complicating IBD.

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