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What is the clinical course and long-term complications of ulcerative colitis?

Long-term ulcerative colitis puts the patient at risk for a number of other conditions. The most common include disease flares, colorectal cancerosteoporosis and nutritional deficiencies.

About two-thirds of patients have a disease course characterized by mild disease controlled by medical therapy. The other 33% experience aggressive disease that requires intensive treatment, and about 15% end up in hospital needing intravenous steroids. The cumulative risk of a disease flare is 60-70% over 10 years. Patients with ulcerative colitis do not die at any higher rates than the general population.

Historically there is a higher risk of colorectal cancer in patients with ulcerative colitis. Anti-inflammatory medication and surveillance  colonoscopy may reduce this risk close to that of the general (non-UC) population. It is important that regular surveillance colonoscopy is performed every one to two years in those with more than eight years of disease, in order to detect early malignant changes in the colon. Patients with extensive disease, young age at diagnosis, a family history of colon cancer, and a diagnosis of primary sclerosing cholangitis have the highest risk of colon cancer in patients with ulcerative colitis.

Thinning of the bones (osteopenia) occurs in about 25% of patients with ulcerative colitis, particularly those who have required steroid therapy. As a consequence, bone mineral density testing is recommended, and treatment with calcium and vitamin D or bisphosphonates is sometimes necessary.

A number of nutritional deficiencies can develop in patients with active disease, including iron, folic acid, vitamin D, calcium, magnesium and vitamin K. Fortunately these tend to occur only with chronically active disease, and improve once remission is obtained. Thus, it is important that patients have these checked and replaced either via diet or supplements.

Ulcerative colitis is an uncommon disease that is effectively managed in most patients with medical therapy. Although the exact cause remains unknown, many of the complications that can occur have been reduced by long-term medication use. Further research into the role of the interaction between bacteria and the human immune system may provide promising methods of preventing or treating this condition in the future.

Contact Information

Inflammatory Bowel Disease Program
Digestive Disease Center
Beth Israel Deaconess Medical Center
330 Brookline Avenue
Boston, MA 02215
617-667-2135