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Inflammatory Bowel Disease (IBD) (cont.)

What Is the Outlook for a Person with Inflammatory Bowel Disease (IBD)?

The typical course of the inflammatory bowel diseases (for the vast majority of persons) includes periods of remission interspersed with occasional flare-ups.

Ulcerative Colitis

  • A person with ulcerative colitis has a 50% probability of having another flare-up during the next 2 years. However, a very broad range of experiences exists; some persons may only have one flare-up over 25 years (as many as 10%); others may have almost constant flare-ups (much less common).
  • Persons with ulcerative colitis involving the rectum and sigmoid at the time of diagnosis have a greater than 50% chance of progressing to more extensive disease and a 12% rate of colectomy over 25 years.
  • More than 70% of persons presenting with proctitis (inflammation of the rectum alone) alone continue to have disease limited to the rectum over 20 years. Most of the patients who develop more extensive disease do so within 5 years of diagnosis.
  • Among persons with ulcerative colitis involving the entire colon, 60% eventually require colectomy, whereas very few persons with proctitis do.
  • Most surgical interventions are required in the first year of disease; the annual colectomy rate after the first year is 1% for all persons with ulcerative colitis. Surgical resection for persons with ulcerative colitis is considered curative for the disease.

Crohn's Disease

  • The course of Crohn's disease is much more variable than that of ulcerative colitis. The clinical activity of Crohn's disease is independent of the anatomic location and extent of the disease.
  • A person in remission has a 42% likelihood of being free of relapse for 2 years and only a 12% likelihood of being free of relapse for 10 years.
  • Over a 4-year period, approximately 25% of persons remain in remission, 25% have frequent flare-ups, and 50% have a course that fluctuates between periods of flare-ups and remissions.
  • Surgery for Crohn's disease, generally is performed for the complications (stricture, stenosis, obstruction, fistula, bleeding) of the disease rather than for the inflammatory disease itself.
  • After operation, there is a high frequency of recurrence of Crohn's disease, generally in a pattern mimicking the original disease pattern, often on one or both sides of the surgical anastomosis.
  • Approximately 33% of persons with Crohn's disease who require surgery will require surgery again within 5 years, and 66% require surgery again within 15 years.
  • Endoscopic evidence for recurrent inflammation is present in 93% of persons 1 year after surgery for Crohn's disease.
  • Surgery is an important treatment option for Crohn's disease, but patients should be aware that it is not curative and that disease recurrence after surgery is the rule.

What Does Inflammatory Bowel Disease (IBD) Look Like (Pictures)?

Stricture, terminal ileum - colonoscopy. Narrowed segment visible upon intubation of the lower small intestine with colonoscope. Relatively little active inflammation is present, indicating this is a cicatrix (scar) stricture.
Media file 1: Stricture, terminal ileum - colonoscopy. Narrowed segment visible upon intubation of the lower small intestine with colonoscope. Relatively little active inflammation is present, indicating this is a cicatrix (scar) stricture.

Enteroenteric (bowel-to-bowel) fistula - small bowel series X-ray films. The narrow-appearing segments filled out relatively normally on subsequent films. Note that barium is just starting to enter the cecum in the right lower quadrant (reader's left), but that barium has also started to enter the sigmoid colon toward the bottom of the picture, thus indicating the presence of a fistula (hole) from small bowel to sigmoid colon.
Media file 2: Enteroenteric (bowel-to-bowel) fistula - small bowel series X-ray films. The narrow-appearing segments filled out relatively normally on subsequent films. Note that barium is just starting to enter the cecum in the right lower quadrant (reader's left), but that barium has also started to enter the sigmoid colon toward the bottom of the picture, thus indicating the presence of a fistula (hole) from small bowel to sigmoid colon.

Media file 3: Severe advanced pyoderma gangrenosum (a rare skin complication of inflammatory bowel disease) is present on the left ankle.
Media file 3: Severe advanced pyoderma gangrenosum (a rare skin complication of inflammatory bowel disease) is present on the left ankle.

Media file 4: Severe colitis - colonoscopy. The mucosa is grossly denuded, with active bleeding noted. This patient had her colon resected very shortly after this view was obtained.
Media file 4: Severe colitis - colonoscopy. The mucosa is grossly denuded, with active bleeding noted. This patient had her colon resected very shortly after this view was obtained.

Media file 5: Toxic megacolon, a rare complication of ulcerative colitis that almost always requires surgical removal of the colon. Courtesy of Dr Pauline Chu.
Media file 5: Toxic megacolon, a rare complication of ulcerative colitis that almost always requires surgical removal of the colon. Courtesy of Dr Pauline Chu.

Media file 6: Episcleritis, inflammation of a portion of the eye in conjunction with inflammatory bowel disease. Courtesy of Dr. David Sevel.
Media file 6: Episcleritis, inflammation of a portion of the eye in conjunction with inflammatory bowel disease. Courtesy of Dr. David Sevel.

Media file 7: Double-contrast barium enema examination in Crohn's colitis demonstrates numerous aphthous ulcers (the tiny spots on the lining of the intestine).
Media file 7: Double-contrast barium enema examination in Crohn's colitis demonstrates numerous aphthous ulcers (the tiny spots on the lining of the intestine).

REFERENCES:

Crohn's & Colitis Foundation of America. "IBS and IBD: Two Very Different Disorders." Published June 1, 2012.
<http://www.ccfa.org/resources/ibs-and-ibd-two-very.html>

Crohn's & Colitis Foundation of America. "What are Crohn's & Colitis?
<http://www.ccfa.org/what-are-crohns-and-colitis/>

Farrell, R.J., MD., et al. "Overview of the medical management of mild to moderate Crohn disease in adults." UpToDate. Updated: Jul 28, 2016.
<http://www.uptodate.com/contents/overview-of-the-medical-management-of-mild-to-moderate-crohn-disease-in-adults>

Rowe, W.A., MD. "Inflammatory Bowel Disease." Medscape. Updated: Jun 17, 2016.
<http://emedicine.medscape.com/article/179037-overview>

Peppercorn, M.A., MD., et al. "Definition, epidemiology, and risk factors in inflammatory bowel disease." UpToDate. Updated: Nov 08, 2016.
<http://www.uptodate.com/contents/definition-epidemiology-and-risk-factors-in-inflammatory-bowel-disease>


Medically Reviewed by a Doctor on 1/6/2017

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