The clinical course and prognosis in ulcerative colitis (UC) and Crohn's disease (CD) have been described in many studies, mostly retrospective. Such studies are hampered by problems such as inclusion over a long time period, proper definitions, incomplete case records, and outdated methods of diagnosis. In a prospective study we identified 846 patients with inflammatory bowel disease (IBD) over a 4-year period from 1990 to 1993. Uniform diagnostic and therapeutic strategies were used as a basis for later assessment of the short-term clinical course in different subgroups of UC and CD and analysis of potential risk factors for relapse or surgery.
At the time of follow-up, a mean of 16.2 months after diagnosis, 496 UC patients and 232 CD patients, altogether 98%, were available for evaluation. A colonoscopy was performed in 88% (410 of 465) of the UC patients attending a clinical examination and in 76% (164 of 216) of the CD patients.
Eleven patients with UC and five patients with CD died during follow-up, four of complications related to IBD. The cumulative 1-year relapse rate in the remaining patients was 50% for UC and 47% for CD. Of the patients with relapses 11 % of the UC patients and 10% of the CD patients had a chronic relapsing course without any difference with regard to the various disease categories in UC or CD. An increased risk of relapse was found in patients less than 50 years old only in UC. In UC a higher risk for surgery was found in patients with extensive colitis compared with left-sided colitis (P = 0.011), and CD patients with small-bowel involvement had a higher risk of surgery than patients with disease confined to the colon (P = 0.021). There was no excess risk of relapse or surgery in smokers as compared with non-smokers or former smokers, nor did the risk of relapse vary with the level of cigarette consumption in either UC or CD patients.
The high relapse rate of around 50% for both UC and CD calls for a review of the existing treatment. Further follow-up will be necessary to improve our ability to make clinical decisions relating to medical and surgical treatment options.
"Investigated non-smokers and former smokers suffered more severe disease, estimated according to ECCO classification, than current smokers (p < 0.05). The analysis, however, did not show any statistical differences in the frequencies of hospitalisations nor immunosuppressant usage among the investigated subgroups, which has also been reported by some authors [19, 21–23]. It has also been implied that smoking significantly lowers the risk of colectomy. "
[Show abstract][Hide abstract] ABSTRACT: Introduction: Cigarette smoking is considered an important risk factor for developing Crohn’s disease (CD), contributing to a more severe course of the disease. Conversely, smoking is believed to have a beneficial effect on the course of ulcerative colitis (UC), a second major condition of inflammatory bowel disease (IBD).
Aim: To investigate the effect of tobacco use on the clinical course of IBD.
Material and methods: A group of 95 adults with IBD were enrolled to the study. Demographic and clinical data of patients as well as their smoking status were analysed based on their medical history. Values were considered significant when p ≤ 0.05.
Results: Current smokers constituted the majority of CD patients. They tended to develop a more severe course of the disease, compared to former smokers and non-smokers. Current smokers suffered a moderate-to-severe form of the disease and required immunosuppressive therapy more frequently. They were also hospitalised and underwent surgeries more frequently than patients from other investigated subgroups. The study failed, however, to fully confirm the beneficial effect of smoking on the clinical outcome of UC. The investigated non-smokers and former smokers suffered a more severe disease, but the analysis did not find any statistical differences in the frequencies of hospitalisations nor immunosuppressant usage among the investigated subgroups.
Conclusions: The study confirmed a detrimental effect of smoking on the outcome of CD, but failed to fully confirm its beneficial effect on UC.
"Several studies have revealed a relationship between the extent of colitis at diagnosis and the risk of colectomy [2-4]. In a recent population-based study from Norway (IBSEN study), extensive colitis at presentation was found to be an independent predictor of colectomy at both 1 year  and 10 years  after diagnosis. Comparable results were obtained by the European Collaborative Study Group of Inflammatory Bowel Disease (EC IBD) study  showing that colectomy was more likely in extensive colitis than in proctitis, with a cumulative hazard ratio of 4.1 (95% confidence interval [CI]: 2.0-8.4). "
[Show abstract][Hide abstract] ABSTRACT: The clinical course of ulcerative colitis (UC) may range from a quiescent course with prolonged periods of remission to fulminant disease requiring intensive medical treatment or surgery. Disease outcome is often determined by relapse rates, the development of colorectal cancer (CRC) and mortality rates. Early patient classification, identifying those with a high risk of developing complicated disease, is essential for choosing appropriate treatment. This paper reviews the clinical outcomes of UC patients as reported in population-based and observational studies representative of the whole patient population. Extensive colitis, a high level of systemic symptoms and young age at diagnosis are factors associated with a high risk of colectomy. Patients with distal disease who progress to extensive colitis seem to be a subgroup with an especially high risk of colectomy. Some prognostic factors of severe disease have been identified which could be used to optimize treatment and possibly reduce future complications. The overall risk of CRC and mortality was not significantly different from that of the background population. These results may have implications for follow-up strategies, especially regarding endoscopic surveillance of UC patients.
"Nonetheless, as for critical features in making a distinction between the two diseases, Crohn's disease is highly likely to be diagnosed among patients who manifest skip lesions, perianal lesions, and a cobblestone appearance, whereas a continuous granularity of the mucosa accompanied by erosions or diminutive ulcers is found more often with ulcerative colitis.17 One- to 2-year follow-up monitoring in a large-scale study demonstrated that the diagnosis were changed in about 10% of cases.18 Thirty-three percent of patients with indeterminate colitis were diagnosed with ulcerative colitis and about 17% with Crohn's disease.19 "
[Show abstract][Hide abstract] ABSTRACT: Colonoscopy plays a crucial role in the diagnosis, treatment and follow-up monitoring of inflammatory bowel disease (IBD). Practitioners should be well informed of the colonoscopic findings of IBD to prevent the misdiagnosis, overtreatment or delayed treatment. Distinguishing between Crohn's disease and ulcerative colitis is essential in terms of pharmacological treatment, surgical decision-making, and prognosis. But there are still lesions with difficulty in differentiation that approximately 10% of the patients fall into the category of indeterminate colitis. Efforts are needed to carefully select treatment approach appropriate for each patient by providing a precise diagnosis on the extent and degree of lesions as well as to accurately delineate the lesions to assure that they are compared in subsequent rounds of follow-up monitoring in order to allow redetermination and adjustment of the treatment.
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