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Persons with inflammatory bowel disease are prone to the development of malignancy (cancer). In Crohn's disease, there is a higher rate of small intestinal malignancy. Persons with involvement of the whole colon, particularly ulcerative colitis, are at a higher risk of developing colonic malignancy after 8 to 10 years of the onset of the disease. For cancer prevention, surveillance colonoscopy every 1 to 2 years after 8 years of disease is recommended.
- Use of corticosteroids may lead to debilitating illness, particularly after long-term use. You should consider trying more aggressive therapies rather than remaining on corticosteroids because of the potential for side effects with these drugs.
- Patients taking steroids should undergo a yearly ophthalmologic examination because of the risk of development of cataracts.
- Persons with IBD may have a reduction in bone density, either from decreased calcium absorption (because of the underlying disease process) or because of corticosteroid use. Crippling osteoporosis can be a very serious complication. If you have significantly low bone density, you will be administered bisphosphonates and calcium supplements.
The typical course of the inflammatory bowel diseases (for the vast majority of persons) includes periods of remission interspersed with occasional flare-ups.
- 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.
- 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.