Ulcerative colitis screening

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Ulcerative colitis Microchapters


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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Tarek Nafee, M.D. [2]


Patients with ulcerative colitis require screening for colorectal carcinoma. In patients with a confirmed diagnosis of ulcerative colitis, the risk of colorectal carcinoma is increased. The American Cancer Society and the American College of Gastroenterology recommend having the initial screening 8 years after the patient is diagnosed with severe disease or when most of, or the entire, large intestine is involved and 12 to 15 years after diagnosis when only the left side of the large intestine is involved.


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.[1] It is recommended that patients have screening colonoscopies with random biopsies to look for dysplasia after eight years of disease activity.[2][3]

Colorectal carcinoma

Due to the risk of colon cancer associated with ulcerative colitis, screening with colonoscopy is recommended. The American Cancer Society recommends the following schedule for colonoscopy:[4]

  • First colonoscopy 8 years after diagnosis with severe disease, or when most of, or the entire, large intestine is involved
  • First colonoscopy 12 - 15 years after diagnosis when only the left side of the large intestine is involved
  • Follow-up colonoscopy should be performed every 1 - 2 years

Have follow-up examinations every 1 - 2 years.

Post-operative surveillance

Inadequate evidence exists to recommend routine surveillance of the pouch for dysplasia or adenocarcinoma.


  1. Ulcerative Colitis Practice Guidelines in Adults, Am. Coll. Gastroenterology, 2004. PDF
  2. 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.
  3. U.S. Preventive Services Task Force (2002). "Screening for colorectal cancer: recommendation and rationale". Am Fam Physician. 66 (12): 2287–90. PMID 12507168.
  4. Kornbluth A, Sachar DB, Practice Parameters Committee of the American College of Gastroenterology (2010). "Ulcerative colitis practice guidelines in adults: American College Of Gastroenterology, Practice Parameters Committee". Am J Gastroenterol. 105 (3): 501–23, quiz 524. doi:10.1038/ajg.2009.727. PMID 20068560.

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