Ulcerative colitis natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Usama Talib, BSc, MD [2]
Overview
Patients with ulcerative colitis experience intermittent symptoms. This means that there are periods of disease inactivity alternating with "flares" of disease. Anemia, bowel perforation, toxic megacolon and colorectal carcinoma are a few known complications of ulcerative colitis. Ulcerative colitis also has a significant association with primary sclerosing cholangitis (PSC). A permanent and complete cure from ulcerative colitis is unusual. 67% patients relapse within 10 years of initial diagnosis.[1][2][1][2]
Natural History
Patients with ulcerative colitis usually have an intermittent course, with periods of disease inactivity alternating with "flares" of disease. Patients with proctitis or left-sided colitis usually have a more benign course: only 15% progress proximally with their disease, and up to 20% can have sustained remission in the absence of any therapy. Patients with more extensive disease are less likely to sustain remission, but the rate of remission is independent of the severity of disease.[1]
Complications
Possible Complications
A few possible complications of ulcerative colitis include:
- Anemia
- Toxic megacolon
- Bowel perforation
- Colorectal carcinoma
- Ankylosing spondylitis
- Cancer
- Colon narrowing
- Complications of corticosteroid therapy
- Impaired growth and sexual development in children
- Inflammation of the joints
- Lesions in the eye
- Liver disease
- Massive bleeding in the colon
- Mouth ulcers
- Pyoderma gangrenosum (skin ulcer)
- Tears or holes (perforation) in the colon
Ulcerative colitis and colorectal cancer
There is a significantly increased risk of colorectal cancer in patients with ulcerative colitis after 10 years if involvement is beyond the splenic flexure. Those with only proctitis or rectosigmoiditis usually have no increased risk.[3] It is recommended that patients have screening colonoscopies with random biopsies to look for dysplasia after eight years of disease activity[4]
Primary sclerosing cholangitis
Ulcerative colitis has a significant association with primary sclerosing cholangitis (PSC), a progressive inflammatory disorder of small and large bile ducts. As many as 5% of patients with ulcerative colitis may progress to develop primary sclerosing cholangitis.[5]
Mortality
The effect of ulcerative colitis on mortality is unclear, but it is thought that the disease primarily affects quality of life, and not lifespan.[6] A few studies show a higher mortality in patient with ulcerative colitis as compared to general population.[7]
Prognosis
The course of the disease generally varies. Ulcerative colitis may be inactive and then get worse over a period of years. Sometimes ulcerative colitis can progress quickly. A permanent and complete cure is unusual.[1][2]
- 67% patients relapse within 10 years of the initial diagnosis.[8]
References
- ↑ 1.0 1.1 1.2 1.3 Roda G, Narula N, Pinotti R, Skamnelos A, Katsanos KH, Ungaro R; et al. (2017). "Systematic review with meta-analysis: proximal disease extension in limited ulcerative colitis". Aliment Pharmacol Ther. 45 (12): 1481–1492. doi:10.1111/apt.14063. PMID 28449361.
- ↑ 2.0 2.1 2.2 Han YD, Al Bandar MH, Dulskas A, Cho MS, Hur H, Min BS; et al. (2017). "Prognosis of ulcerative colitis colorectal cancer vs. sporadic colorectal cancer: propensity score matching analysis". BMC Surg. 17 (1): 28. doi:10.1186/s12893-017-0224-z. PMC 5359905. PMID 28327112.
- ↑ Ulcerative Colitis Practice Guidelines in Adults, Am. Coll. Gastroenterology, 2004. PDF
- ↑ Leighton JA, Shen B, Baron TH, Adler DG, Davila R, Egan JV, Faigel DO, Gan SI, Hirota WK, Lichtenstein D, Qureshi WA, Rajan E, Zuckerman MJ, VanGuilder T, Fanelli RD; Standards of Practice Committee, American Society for Gastrointestinal Endoscopy. ASGE guideline: endoscopy in the diagnosis and treatment of inflammatory bowel disease. Gastrointest Endosc 2006;63:558-65. PMID 16564852.
- ↑ Olsson R, Danielsson A, Jarnerot G, Lindstrom E, Loof L, Rolny P, Ryden BO, Tysk C, Wallerstedt S. Prevalence of primary sclerosing cholangitis in patients with ulcerative colitis. Gastroenterology 1991;100(5 Pt 1):1319-23. PMID 2013375.
- ↑ Jess T, Gamborg M, Munkholm P, Sørensen TI (2007). "Overall and cause-specific mortality in ulcerative colitis: meta-analysis of population-based inception cohort studies". Am J Gastroenterol. 102 (3): 609–17. doi:10.1111/j.1572-0241.2006.01000.x. PMID 17156150.
- ↑ Jess T, Frisch M, Simonsen J (2013). "Trends in overall and cause-specific mortality among patients with inflammatory bowel disease from 1982 to 2010". Clin Gastroenterol Hepatol. 11 (1): 43–8. doi:10.1016/j.cgh.2012.09.026. PMID 23022699.
- ↑ Solberg IC, Lygren I, Jahnsen J, Aadland E, Høie O, Cvancarova M; et al. (2009). "Clinical course during the first 10 years of ulcerative colitis: results from a population-based inception cohort (IBSEN Study)". Scand J Gastroenterol. 44 (4): 431–40. doi:10.1080/00365520802600961. PMID 19101844.