Ulcerative Colitis

Risks

Inflammation in ulcerative colitis is confined to the surface of the bowel. As a result, patients do not develop fistula and typically do not have bowel blockage. Patients with severe disease can develop megacolon, where the colon dilates and may rupture. Megacolon is rare but usually requires emergency removal of the colon. Patients may also develop anemia, which usually can be controlled. Some patients may also develop osteoporosis (thinning bones), especially if they are taking corticosteroids. Osteoporosis can be monitored by a simple test and treated.

The most feared complication of ulcerative colitis is colorectal cancer. The risk of colorectal cancer in someone with ulcerative colitis is related to how much of the colon is involved and how long the patient has the disease. Patients whose disease is confined to the rectal area don't seem to have an increased risk. The risk begins to increase in those who have pancolitis (extensive involvement) and who have had the disease for eight years or more. The risk is also increased in patients with left-sided colitis after approximately 10 to 15 years of disease. Patients should discuss with their doctor whether they need a colon cancer surveillance program. Typically this involves annual colonoscopies. During the colonoscopy, the physician will take random biopsies of the colon to look for early warning signs of cancer, so that if cancer develops it can be treated at a curable stage.