Prognosis of ulcerative colitis
Ulcerative colitis is an intermittent disease with periods of remission and exacerbation. Proctitis and left-sided colitis are mild types with a benign course. The diseases progress proximally only in 15% of people with these types, and 20% of them have remission for long periods independent of treatment. People with more extensive types have shorter periods of remission. Some patients have rapidly progressive disease, and these people usually don’t respond to the treatment, and they will need surgery within a few years of the disease onset.
The need for surgery varies according to the patient’s condition, but some risk factors raise this need, such as:
- An extensive disease that involves most of the large intestine
- Severe inflammation and persistent elevated inflammatory markers
- Previous history of hospitalization due to ulcerative colitis
- Young age patients
Ulcerative colitis doesn’t usually affect the fertility of patients, especially female patients. But, infertility may occur as a complication of surgery, especially pouch surgery. The risk of infertility is lower in the end ileostomy surgical procedure.
Female patients, who decide to be pregnant, will mostly get a healthy child without problems in pregnancy. But, pregnant females with ulcerative colitis should review the management plan with the health care team. Doctors may change some medication to avoid any adverse effects. Also, the doctor will recommend the control of ulcerative colitis before pregnancy to prevent flares during the pregnancy.
Ulcerative colitis in children manifests as in adults. But, it may impact the child growth and development. Some medications may be unsuitable for children, such as enemas and immunosuppressants. Thus, surgery may be essential to control the disease in children.
The risk of colorectal cancer increases -after ten years of disease onset-, especially when the disease involves more than the descending (left-sided) colon. People with only proctitis don’t have a high risk of cancer. Screening colonoscopies and biopsies are essential to identify any precancerous lesion and remove it.
The risk of mortality in ulcerative colitis isn’t higher than the general population. But, the causes of death in these patients differ from the general population. Infection with some organisms, such as clostridium difficile and cytomegalovirus (CMV), may predict a higher risk of mortality.
