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: Aug 7, 2008

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. See related CME at Guidelines Issued for Early Detection of Colorectal Cancer.
  • If high-grade dysplasia or cancer is found, colectomy is performed. 
  • The management of low-grade dysplasia is controversial; 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
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References

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  8. 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].

  9. 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].

  10. 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].

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Further Reading

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Keywords

ulcerative colitis, UC, inflammatory bowel disease, IBD, Crohn’s disease, Crohn disease, irritable bowel syndrome, IBS, 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 and Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
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