gastrointestinal disorders
Ulcerative Colitis
Prognosis for Ulcerative Colitis
Usually, ulcerative colitis is chronic with repeated exacerbations and remissions. In some of patients, an initial attack becomes fulminant with massive hemorrhage, perforation, or sepsis and toxemia. Complete recovery after a single attack occurs in a few patients. Patients with localized ulcerative proctitis have the best prognosis. Severe systemic manifestations, toxic complications, and malignant degeneration are unlikely, and late extension of the disease occurs only in a small group of patients. Surgery is rarely required, and life expectancy is normal. The symptoms, however, may prove stubborn and refractory. Moreover, because extensive ulcerative colitis may begin in the rectum and spread proximally, proctitis should not be considered localized until it has been observed for≥6 months. Localized disease that later extends is often more severe and more refractory to therapy. The risk of Colorectal Cancer is proportional to the duration of disease and amount of colon affected but not necessarily to the clinical severity of the attacks. Some studies suggest that sustained microscopic inflammation is a risk factor, and that use of 5-aminosalicylic acid (5-ASA) to control inflammation is protective. The high risk of colon cancer conferred by IBD has been noted in multiple studies. More recent data suggests that the prevalence of colon cancer is decreasing and was overestimated by researches at tertiary care centers ( Prognosis references ). Patients who have inflammatory bowel disease and primary sclerosing cholangitis are at a higher risk of cancer from the time of colitis diagnosis. 8 to 10 years (except for those with isolated proctitis) or when there is concomitant primary sclerosing cholangitis, in which case surveillance colonoscopy should begin at the time of diagnosis. The guidelines ( Prognosis references ) suggest doing The optimal frequency of colonoscopic surveillance has not been established, but some authorities recommend every 2 years during the 2nd decade of disease and annually thereafter. Long-term survival after diagnosis of colitis-related cancer is about 50%, a figure comparable to that for colorectal cancer in the general population. 1.Stidham RW, Higgins PDR: Colorectal cancer in inflammatory bowel disease.Clin Colon Rectal Surg31(3):168-178, 2018. doi: 10.1055/s-0037-1602237 2.Laine L, Kaltenbach T, Barkun A, et al: SCENIC international consensus statement on surveillance and management of dysplasia in inflammatory bowel disease.Gastroenterology148(3):639-651.e28, 2015. doi: 10.1053/j.gastro.2015.01.031 