eMedicine Specialties > Gastroenterology > Colon

Ulcerative Colitis: Follow-up

Author: Tri H Le, MD, Assistant Professor of Medicine, Division of Gastroenterology and Hepatology, Penn State Milton S Hershey Medical Center
Contributor Information and Disclosures

Updated: Dec 28, 2009

Follow-up

Further Outpatient Care

  • A screening colonoscopy is recommended for all patients with ulcerative colitis 8-10 years after the onset of symptoms to rule out colonic neoplasia and to reclassify the extent of disease.
  • Patients with extensive colitis or left-sided colitis with negative findings on screening colonoscopy should begin surveillance colonoscopy in 1-2 years.
  • For patients with ulcerative colitis and primary sclerosing cholangitis, screening and subsequent surveillance colonoscopy begin on an annual basis at the time of onset of primary sclerosing cholangitis.
  • Patients with proctosigmoiditis have no increased risk for colorectal cancer compared with the general population. However, these patients should be managed according to the current guidelines on colorectal cancer screening.
  • If high-grade dysplasia or cancer is found, colectomy is performed.
  • The management of low-grade dysplasia is controversial5 ; however, most experts would recommend colectomy.

Complications

  • Toxic megacolon occurs in less than 2% of cases and can be induced by hypokalemia, opiates, anticholinergics, and barium enemas. Patients are acutely ill. Conservative treatment can be tried for 24-48 hours with IV fluids, IV steroids, antibiotics, and IV cyclosporine. Patients may eventually require a total colectomy.
  • The risk of colorectal cancer increases by 0.5-1% per year. Regular surveillance is needed.

Prognosis

  • Most cases are controlled with medical therapies, with the patient experiencing lifelong exacerbations and remissions. In more severe cases, surgery results in a cure.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Colonoscopy performed in patients with severely active disease can cause significant complications, such as perforation or toxic megacolon.
  • Barium enemas performed in severe cases can precipitate toxic megacolon.
  • Adverse effects due to medical therapy can be frequent; therefore, routine laboratory monitoring should be followed.
  • Screening colonoscopy with subsequent surveillance colonoscopy should be initiated 8-10 years after the onset of symptoms of ulcerative colitis.

Special Concerns

  • Pregnancy
  • Sclerosing cholangitis and cholangiocarcinoma
  • Extracolonic manifestations
 


More on Ulcerative Colitis

Overview: Ulcerative Colitis
Differential Diagnoses & Workup: Ulcerative Colitis
Treatment & Medication: Ulcerative Colitis
Follow-up: Ulcerative Colitis
Multimedia: Ulcerative Colitis
References
Further Reading
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References

  1. Jang ES, Lee DH, Kim J, et al. Age as a clinical predictor of relapse after induction therapy in ulcerative colitis. Hepatogastroenterology. Sep-Oct 2009;56(94-95):1304-9. [Medline].

  2. Andersson T, Lunde OC, Johnson E, et al. Long-term functional outcome and quality of life after restorative proctocolectomy with ileo-anal anastomosis for colitis. Colorectal Dis. Dec 14 2009;[Medline].

  3. da Luz Moreira A, Kiran RP, Lavery I. Clinical outcomes of ileorectal anastomosis for ulcerative colitis. Br J Surg. Jan 2010;97(1):65-9. [Medline].

  4. Parente F, Molteni M, Marino B, et al. Are colonoscopy and bowel ultrasound useful for assessing response to short-term therapy and predicting disease outcome of moderate-to-severe forms of ulcerative colitis?: a prospective study. Am J Gastroenterol. Dec 8 2009;[Medline].

  5. Pekow JR, Hetzel JT, Rothe JA, et al. Outcome after surveillance of low-grade and indefinite dysplasia in patients with ulcerative colitis. Inflamm Bowel Dis. Dec 21 2009;[Medline].

  6. Alcalde Encinas MM, Perez-Gracia A, Hallal H, et al. [Cerebral venous sinus thrombosis and ulcerative colitis]. Rev Esp Enferm Dig. Feb 2000;92(2):105-8. [Medline].

  7. Brown MO. Inflammatory bowel disease. Prim Care. Mar 1999;26(1):141-70. [Medline].

  8. Fichera A, Michelassi F. Indication for surgery: a surgeon's opinion. In: Sartor RB, Sandborn WJ. Kirsner's Inflammatory Bowel Diseases. 6th ed. New York: Saunders; 2004:596-601/39.

  9. Froehlich F, Larequi-Lauber T, Gonvers JJ, et al. 11. Appropriateness of colonoscopy: inflammatory bowel disease. Endoscopy. Oct 1999;31(8):647-53. [Medline].

  10. Hanauer SB. Inflammatory bowel disease. N Engl J Med. Mar 28 1996;334(13):841-8. [Medline].

  11. Itzkowitz SH, Present DH. Consensus conference: Colorectal cancer screening and surveillance in inflammatory bowel disease. Inflamm Bowel Dis. Mar 2005;11(3):314-21. [Medline].

  12. Jayanthi V, Probert CS, Mayberry JF. Epidemiology of inflammatory bowel disease. Q J Med. Jan 1991;78(285):5-12. [Medline].

  13. Kamm MA, Sandborn WJ, Gassull M, et al. Once-daily, high-concentration MMX mesalamine in active ulcerative colitis. Gastroenterology. Jan 2007;132(1):66-75; quiz 432-3. [Medline].

  14. Kornbluth A, Sachar DB. Ulcerative colitis practice guidelines in adults (update): American College of Gastroenterology, Practice Parameters Committee. Am J Gastroenterol. Jul 2004;99(7):1371-85. [Medline].

  15. Lichtenstein GR, Abreu MT, Cohen R, et al. American Gastroenterological Association Institute technical review on corticosteroids, immunomodulators, and infliximab in inflammatory bowel disease. Gastroenterology. Mar 2006;130(3):940-87. [Medline].

  16. Rioux JD, Silverberg MS, Daly MJ, et al. Genomewide search in Canadian families with inflammatory bowel disease reveals two novel susceptibility loci. Am J Hum Genet. Jun 2000;66(6):1863-70. [Medline].

  17. Stenson WF, Korzenik J. Inflammatory bowel disease. In: Yamada T, ed. Textbook Of Gastroenterology. Vol 2. 4th ed. Philadephia: Lippincott Williams & Wilkins; 2003:1699-1759.

  18. Thomas GA, Rhodes J, Green JT. Role of smoking in inflammatory bowel disease: implications for therapy. Postgrad Med J. May 2000;76(895):273-9. [Medline].

  19. Tremaine WJ. Collagenous colitis and lymphocytic colitis. J Clin Gastroenterol. Apr 2000;30(3):245-9. [Medline].

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Further Reading

Clinical guidelines:
American Gastroenterological Association Institute medical position statement on corticosteroids, immunomodulators, and infliximab in inflammatory bowel disease. American Gastroenterological Association Institute - Medical Specialty Society. 2006 Mar. 5 pages. NGC:004873

Practice parameters for the surgical treatment of ulcerative colitis. American Society of Colon and Rectal Surgeons - Medical Specialty Society. 1997 (revised 2005 Nov). 13 pages. NGC:005612

Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. American Cancer Society - Disease Specific Society
American College of Radiology - Medical Specialty Society
U.S. Multisociety Task Force on Colorectal Cancer - Medical Specialty Society. 2001 (revised 2008 May-Jun). 31 pages. NGC:007214

Screening for colorectal cancer: U.S. Preventive Services Task Force recommendation statement. United States Preventive Services Task Force - Independent Expert Panel. 1996 (revised 2008 Oct). 11 pages. NGC:006722

Clinical trials:
Chromoendoscopy for Ulcerative Colitis Surveillance

Immune Regulation in Ulcerative Colitis or Crohn's Disease

Melatonin & Ulcerative Colitis (Melatonin & UC)

Safety and Activity of ORE1001 in Subjects With Ulcerative Colitis

Study of the Safety and Tolerability of ALTH12 Versus Mesalamine Enema in Subjects With Left-Sided Ulcerative Colitis

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Keywords

ulcerative colitis, IBS, colitis, Crohn’s disease, Crohn disease, irritable bowel syndrome, IBD, inflammatory bowel disease, ulcerative colitis treatment, ulcerative colitis symptoms, colonic inflammation, rectal inflammation, toxic megacolon, ileus, diverticulitis, primary sclerosing cholangitis, rectal bleeding, bloody bowel movements

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Contributor Information and Disclosures

Author

Tri H Le, MD, Assistant Professor of Medicine, Division of Gastroenterology and Hepatology, Penn State Milton S Hershey Medical Center
Tri H Le, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, American Society of Gastrointestinal Endoscopy, and Crohns and Colitis Foundation of America
Disclosure: Nothing to disclose.

Medical Editor

Anil Minocha, MD, FACP, FACG, Clinical Professor, School of Pharmacy, Professor of Medicine, Director of Digestive Diseases, Medical Director of Nutrition Support, Medical Director of Gastrointestinal Endoscopy, Internal Medicine Department, University of Mississippi Medical Center
Anil Minocha, MD, FACP, FACG is a member of the following medical societies: American Academy of Clinical Toxicology, American Association for the Study of Liver Diseases, American College of Forensic Examiners, American College of Gastroenterology, American College of Physicians, American Federation for Clinical Research, American Gastroenterological Association, and American Society of Gastrointestinal Endoscopy
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Noel Williams, MD, Professor Emeritus, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Professor, Department of Internal Medicine, Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
Noel Williams, MD is a member of the following medical societies: Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

CME Editor

Alex J Mechaber, MD, FACP, Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD, Clinical Professor of Medicine, Drexel University College of Medicine; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania
Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law, Medicine & Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
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