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The Prognosis of Inflammatory Bowel Disease

The Prognosis of Inflammatory Bowel Disease Abstract • The complications of ulcerative colitis generally develop during the first two years of disease. The mortality is higher than expected and the highest likelihood of colectomy also occurs early in the disease. Mortality in Crohn's disease is greater than expected, especially in males. For both conditions, the overall mortality has decresed steadily, and currently is less than 5%. Ulcerative colitis is curable with proctocolectomy and ileostomy. In Crohn's disease, intestinal resection and reanastomosis is followed by recurrence in the majority of patients. The recurrence rate after proctocolectomy and ileostomy for Crohn's disease of the colon also is considerable, ranging from 20% to 35%. In ulcerative colitis, the more colon involved, the more frequent and more serious are the complications. In Crohn's disease, the anatomic pattern of disease tends to predict the type and extent of complications. Both ulcerative colitis and Crohn's disease appear to follow a more severe course in children and adolescents with "inflammatory bowel disease." Patients with either ulcerative colitis or Crohn's disease are at increased risk for the later development of cancer. In ulcerative colitis, the excess risk is limited to colorectal cancer. Patients with Crohn's disease have increased cancer rates for both the small and large bowel. Finally, most patients with these diseases are able to maintain normal occupations and enjoy reasonably stable social and economic situations. The successful adaptation of patients with inflammatory bowel disease is influenced by a hopeful, optimistic personality and by an encouraging, supportive physician. (Arch Intern Med 1983;143:294-299) References 1. Mendeloff AI: The epidemiology of inflammatory bowel disease. Clin Gastroenterol 1980;9:259-270. 2. Kirsner JB, Shorter RG: Recent developments in 'non-specific' inflammatory bowel disease. N Engl J Med 1982;306:775-785, 837-848.Crossref 3. Bonnevie O, Binder V, Anthonisen P, et al: The prognosis of ulcerative colitis. Scand J Gastroenterol 1974;9:81-91. 4. Ritchie JK, Powell-Tuck J, Lennard-Jones JE: Clinical outcome of the first ten years of ulcerative colitis and proctitis. Lancet 1978;1:1140-1143.Crossref 5. McDermott F, Hughes ESR, Pihl E: Mortality and morbidity in Crohn's disease and ulcerative colitis in Australia. Med J Aust 1980;1:534-536. 6. Edwards FC, Truelove SC: The course and prognosis of ulcerative colitis. Gut 1963;4:299-315Crossref 7. 5:1-22. 8. Gilat T, Vilos P, Benaroya Y, et al: Risk factors in ulcerative colitis. Digestion 1976;14:400-408.Crossref 9. Binder V, Bonnevie O, Gertz TC, et al: Ulcerative colitis in children: Treatment, course and prognosis. Scand J Gastroenterol 1973;8:161-167.Crossref 10. Michener WM, Farmer RG, Mortimer EA: Long-term prognosis of ulcerative colitis with onset in childhood or adolescence. J Clin Gastroenterol 1979;1:301-305.Crossref 11. Whelan D: Cancer risk in ulcerative colitis: Why are results in the literature so varied? Clin Gastroenterol 1980;9:469-476. 12. Devroede G, Taylor WF: On calculating cancer risk and survival of ulcerative colitis patients with the life table method. Gastroenterology 1976;71:505-509. 13. Devroede G, Taylor WF, Sauer WG, et al: Cancer risk and life expectancy of children with ulcerative colitis. N Engl J Med 1971;285:17-21.Crossref 14. Greenstein AJ, Sachar DB, Smith H, et al: Cancer in universal and left-sided ulcerative colitis: Factors determining risk. Gastroenterology 1979;77:290-294. 15. Goldgraber MB, Kirsner JB: Carcinoma of the colon in ulcerative colitis. Cancer 1964;17:657-665.Crossref 16. Van Heerden JA, Beart RW Jr: Carcinoma of the colon and rectum complicating chronic ulcerative colitis. Dis Colon Rectum 1980;23:155-159.Crossref 17. Hughes RG, Hall TJ, Block GE, et al: The prognosis of carcinoma of the colon and rectum complicating ulcerative colitis. Surg Gynecol Obstet 1978;146:46-48. 18. Blackstone MO, Riddell RH, Rogers BHG, et al: Dysplasia-associated lesion or mass detected by colonoscopy in long-standing ulcerative colitis: An indication of colectomy. Gastroenterology 1981;80:366-374. 19. Riddell RH, Goldman H, Ahren C, et al: International Cooperative Study of Epithelial Dysplasia in Ulcerative Colitis: IBD-dysplasia morphology study group, abstracted. Gastoenterology 1981;80:1181. 20. Wheelock FC Jr, Warren R: Ulcerative colitis: Follow-up studies. N Engl J Med 1955;252:421-425.Crossref 21. Korelitz BI, Lindner AE: The influence of corticotropin and adrenal steroids on the course of ulcerative colitis: A comparison with the presteroid era. Gastroenterology 1964;46:671-679. 22. Spencer JA, Kirsner JB, Mlynaryk P, et al: Immediate and prolonged therapeutic effects of corticotropin and adrenal steroids in ulcerative colitis. Gastroenterology 1962;42:113-129. 23. Storgaard L, Bischoff N, Henriksen TW, et al: Survival rate in Crohn's disease and ulcerative colitis. Scand J Gastroenterol 1979;14:225-230.Crossref 24. Jalan KN, Prescott RJ, Sircus W, et al: An experience of ulcerative colitis: III. Long-term outcome. Gastroenterology 1970;59:598-609. 25. Jalan KN, Prescott RJ, Sircus W, et al: An experience of ulcerative colitis: II. Short-term outcome. Gastroenterology 1970;59:589-597. 26. Barnes GL, Campbell PE, Chow CW, et al: Colectomy and cancer in Melbourne children with ulcerative colitis. Med J Aust 1980;2:84-87. 27. Hendricksen C, Binder V: Social prognosis in patients with ulcerative colitis. Br Med J 1980;2:581-587.Crossref 28. Morowitz DA, Kirsner JB: Mortality in ulcerative colitis: 1930 to 1966. Gastroenterology 1969;57:481-490. 29. Farmer RG, Hawk WA, Turnbull RB: Clinical patterns in Crohn's disease. Gastroenterology 1975;68:627-635. 30. Gryboski JD, Spiro HM: Prognosis in children with Crohn's disease. Gastroenterology 1978;74:807-817. 31. Hellers G: Crohn's disease in Stockholm county, 1955-1974. Acta Chir Scand Suppl 1979;490:1-84. 32. Mekjian HS, Switz DM, Watts HD, et al: National Cooperative Crohn's Disease Study: Factors determining recurrence of Crohn's disease after surgery. Gastroenterology 1979;77:907-913. 33. Cooke WT, Mallas E, Prior P, et al: Crohn's disease: Course, treatment and long-term prognosis. Q J Med 1980;49:363-384. 34. Banks BM, Zetzel L, Richter HS: Morbidity and mortality in regional enteritis. Am J Dig Dis 1969;14:369-379.Crossref 35. DeDombal FT, Burton IL, Clamp SE, et al: Short-term course and prognosis of Crohn's disease. Gut 1974;15:435-443.Crossref 36. Locke MR, Farmer RG, Fazio VW, et al: Recurrence and reoperation for Crohn's disease: The role of disease location in prognosis. N Engl J Med 1981;304:1586-1588.Crossref 37. DeDombal FT, Burton IL, Goligher JC: Recurrence of Crohn's disease after primary excisional surgery. Gut 1971;12:519-527.Crossref 38. Greenstein AJ, Sachar DB, Pasternak BS, et al: Reoperation and recurrence in Crohn's colitis and ileocolitis: Crude and cumulative rates. N Engl J Med 1975;293:685-690.Crossref 39. Gump FE, Sakellariadis P, Wolff M, et al: Clinical-pathological investigation of regional enteritis as a guide to prognosis. Ann Surg 1972;176:233-242.Crossref 40. Glass RE, Baker WNW: Role of the granulomas in recurrent Crohn's disease. Gut 1976;17:75-77.Crossref 41. Greenstein AJ, Sachar DB, Smith H, et al: Patterns of neoplasia in Crohn's disease and ulcerative colitis. Cancer 1980;46:403-407.Crossref 42. Weedon DD, Shorter RG, Ilstrup DM, et al: Crohn's disease and cancer. N Engl J Med 1973;289:1099-1103.Crossref 43. Gyde SN, Prior P, Macartny JC, et al: Malignancy in Crohn's disease. Gut 1980;21:1024-1029.Crossref 44. Traube J, Simpson S, Riddell RH, et al: Crohn's disease and adenocarcinoma of the bowel. Dig Dis Sci 1980;25:939-944.Crossref 45. Prior P, Gyde SN, Cooke WT, et al: Mortality in Crohn's disease. Gastroenterology 1981;80:307-312. 46. Truelove SC, Pena AS: Course and prognosis of Crohn's disease. Gut 1976;17:192-201.Crossref 47. Mayberry JF, Newcombe RG, Rhodes J: Mortality in Crohn's disease. Q J Med 1980;49:63-68. 48. Farmer RG, Michener WM: Prognosis of Crohn's disease with onset in childhood or adolescence. Dig Dis Sci 1979;24:752-757.Crossref 49. Prior P, Fielding JF, Waterhouse JA, et al: Mortality in Crohn's disease. Lancet 1970;1:1135-1137.Crossref 50. Meyers S, Walfish JS, Sachar DB, et al: Quality of life after surgery for Crohn's disease: A psychosocial survey. Gastroenterology 1980;78:1-6. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

The Prognosis of Inflammatory Bowel Disease

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Publisher
American Medical Association
Copyright
Copyright © 1983 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1983.00350020120022
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Abstract

Abstract • The complications of ulcerative colitis generally develop during the first two years of disease. The mortality is higher than expected and the highest likelihood of colectomy also occurs early in the disease. Mortality in Crohn's disease is greater than expected, especially in males. For both conditions, the overall mortality has decresed steadily, and currently is less than 5%. Ulcerative colitis is curable with proctocolectomy and ileostomy. In Crohn's disease, intestinal resection and reanastomosis is followed by recurrence in the majority of patients. The recurrence rate after proctocolectomy and ileostomy for Crohn's disease of the colon also is considerable, ranging from 20% to 35%. In ulcerative colitis, the more colon involved, the more frequent and more serious are the complications. In Crohn's disease, the anatomic pattern of disease tends to predict the type and extent of complications. Both ulcerative colitis and Crohn's disease appear to follow a more severe course in children and adolescents with "inflammatory bowel disease." Patients with either ulcerative colitis or Crohn's disease are at increased risk for the later development of cancer. In ulcerative colitis, the excess risk is limited to colorectal cancer. Patients with Crohn's disease have increased cancer rates for both the small and large bowel. Finally, most patients with these diseases are able to maintain normal occupations and enjoy reasonably stable social and economic situations. The successful adaptation of patients with inflammatory bowel disease is influenced by a hopeful, optimistic personality and by an encouraging, supportive physician. (Arch Intern Med 1983;143:294-299) References 1. Mendeloff AI: The epidemiology of inflammatory bowel disease. Clin Gastroenterol 1980;9:259-270. 2. Kirsner JB, Shorter RG: Recent developments in 'non-specific' inflammatory bowel disease. N Engl J Med 1982;306:775-785, 837-848.Crossref 3. Bonnevie O, Binder V, Anthonisen P, et al: The prognosis of ulcerative colitis. Scand J Gastroenterol 1974;9:81-91. 4. Ritchie JK, Powell-Tuck J, Lennard-Jones JE: Clinical outcome of the first ten years of ulcerative colitis and proctitis. Lancet 1978;1:1140-1143.Crossref 5. McDermott F, Hughes ESR, Pihl E: Mortality and morbidity in Crohn's disease and ulcerative colitis in Australia. Med J Aust 1980;1:534-536. 6. Edwards FC, Truelove SC: The course and prognosis of ulcerative colitis. Gut 1963;4:299-315Crossref 7. 5:1-22. 8. Gilat T, Vilos P, Benaroya Y, et al: Risk factors in ulcerative colitis. Digestion 1976;14:400-408.Crossref 9. Binder V, Bonnevie O, Gertz TC, et al: Ulcerative colitis in children: Treatment, course and prognosis. Scand J Gastroenterol 1973;8:161-167.Crossref 10. Michener WM, Farmer RG, Mortimer EA: Long-term prognosis of ulcerative colitis with onset in childhood or adolescence. J Clin Gastroenterol 1979;1:301-305.Crossref 11. Whelan D: Cancer risk in ulcerative colitis: Why are results in the literature so varied? Clin Gastroenterol 1980;9:469-476. 12. Devroede G, Taylor WF: On calculating cancer risk and survival of ulcerative colitis patients with the life table method. Gastroenterology 1976;71:505-509. 13. Devroede G, Taylor WF, Sauer WG, et al: Cancer risk and life expectancy of children with ulcerative colitis. N Engl J Med 1971;285:17-21.Crossref 14. Greenstein AJ, Sachar DB, Smith H, et al: Cancer in universal and left-sided ulcerative colitis: Factors determining risk. Gastroenterology 1979;77:290-294. 15. Goldgraber MB, Kirsner JB: Carcinoma of the colon in ulcerative colitis. Cancer 1964;17:657-665.Crossref 16. Van Heerden JA, Beart RW Jr: Carcinoma of the colon and rectum complicating chronic ulcerative colitis. Dis Colon Rectum 1980;23:155-159.Crossref 17. Hughes RG, Hall TJ, Block GE, et al: The prognosis of carcinoma of the colon and rectum complicating ulcerative colitis. Surg Gynecol Obstet 1978;146:46-48. 18. Blackstone MO, Riddell RH, Rogers BHG, et al: Dysplasia-associated lesion or mass detected by colonoscopy in long-standing ulcerative colitis: An indication of colectomy. Gastroenterology 1981;80:366-374. 19. Riddell RH, Goldman H, Ahren C, et al: International Cooperative Study of Epithelial Dysplasia in Ulcerative Colitis: IBD-dysplasia morphology study group, abstracted. Gastoenterology 1981;80:1181. 20. Wheelock FC Jr, Warren R: Ulcerative colitis: Follow-up studies. N Engl J Med 1955;252:421-425.Crossref 21. Korelitz BI, Lindner AE: The influence of corticotropin and adrenal steroids on the course of ulcerative colitis: A comparison with the presteroid era. Gastroenterology 1964;46:671-679. 22. Spencer JA, Kirsner JB, Mlynaryk P, et al: Immediate and prolonged therapeutic effects of corticotropin and adrenal steroids in ulcerative colitis. Gastroenterology 1962;42:113-129. 23. Storgaard L, Bischoff N, Henriksen TW, et al: Survival rate in Crohn's disease and ulcerative colitis. Scand J Gastroenterol 1979;14:225-230.Crossref 24. Jalan KN, Prescott RJ, Sircus W, et al: An experience of ulcerative colitis: III. Long-term outcome. Gastroenterology 1970;59:598-609. 25. Jalan KN, Prescott RJ, Sircus W, et al: An experience of ulcerative colitis: II. Short-term outcome. Gastroenterology 1970;59:589-597. 26. Barnes GL, Campbell PE, Chow CW, et al: Colectomy and cancer in Melbourne children with ulcerative colitis. Med J Aust 1980;2:84-87. 27. Hendricksen C, Binder V: Social prognosis in patients with ulcerative colitis. Br Med J 1980;2:581-587.Crossref 28. Morowitz DA, Kirsner JB: Mortality in ulcerative colitis: 1930 to 1966. Gastroenterology 1969;57:481-490. 29. Farmer RG, Hawk WA, Turnbull RB: Clinical patterns in Crohn's disease. Gastroenterology 1975;68:627-635. 30. Gryboski JD, Spiro HM: Prognosis in children with Crohn's disease. Gastroenterology 1978;74:807-817. 31. Hellers G: Crohn's disease in Stockholm county, 1955-1974. Acta Chir Scand Suppl 1979;490:1-84. 32. Mekjian HS, Switz DM, Watts HD, et al: National Cooperative Crohn's Disease Study: Factors determining recurrence of Crohn's disease after surgery. Gastroenterology 1979;77:907-913. 33. Cooke WT, Mallas E, Prior P, et al: Crohn's disease: Course, treatment and long-term prognosis. Q J Med 1980;49:363-384. 34. Banks BM, Zetzel L, Richter HS: Morbidity and mortality in regional enteritis. Am J Dig Dis 1969;14:369-379.Crossref 35. DeDombal FT, Burton IL, Clamp SE, et al: Short-term course and prognosis of Crohn's disease. Gut 1974;15:435-443.Crossref 36. Locke MR, Farmer RG, Fazio VW, et al: Recurrence and reoperation for Crohn's disease: The role of disease location in prognosis. N Engl J Med 1981;304:1586-1588.Crossref 37. DeDombal FT, Burton IL, Goligher JC: Recurrence of Crohn's disease after primary excisional surgery. Gut 1971;12:519-527.Crossref 38. Greenstein AJ, Sachar DB, Pasternak BS, et al: Reoperation and recurrence in Crohn's colitis and ileocolitis: Crude and cumulative rates. N Engl J Med 1975;293:685-690.Crossref 39. Gump FE, Sakellariadis P, Wolff M, et al: Clinical-pathological investigation of regional enteritis as a guide to prognosis. Ann Surg 1972;176:233-242.Crossref 40. Glass RE, Baker WNW: Role of the granulomas in recurrent Crohn's disease. Gut 1976;17:75-77.Crossref 41. Greenstein AJ, Sachar DB, Smith H, et al: Patterns of neoplasia in Crohn's disease and ulcerative colitis. Cancer 1980;46:403-407.Crossref 42. Weedon DD, Shorter RG, Ilstrup DM, et al: Crohn's disease and cancer. N Engl J Med 1973;289:1099-1103.Crossref 43. Gyde SN, Prior P, Macartny JC, et al: Malignancy in Crohn's disease. Gut 1980;21:1024-1029.Crossref 44. Traube J, Simpson S, Riddell RH, et al: Crohn's disease and adenocarcinoma of the bowel. Dig Dis Sci 1980;25:939-944.Crossref 45. Prior P, Gyde SN, Cooke WT, et al: Mortality in Crohn's disease. Gastroenterology 1981;80:307-312. 46. Truelove SC, Pena AS: Course and prognosis of Crohn's disease. Gut 1976;17:192-201.Crossref 47. Mayberry JF, Newcombe RG, Rhodes J: Mortality in Crohn's disease. Q J Med 1980;49:63-68. 48. Farmer RG, Michener WM: Prognosis of Crohn's disease with onset in childhood or adolescence. Dig Dis Sci 1979;24:752-757.Crossref 49. Prior P, Fielding JF, Waterhouse JA, et al: Mortality in Crohn's disease. Lancet 1970;1:1135-1137.Crossref 50. Meyers S, Walfish JS, Sachar DB, et al: Quality of life after surgery for Crohn's disease: A psychosocial survey. Gastroenterology 1980;78:1-6.

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Feb 1, 1983

References