Ulcerative colitis: no increase noted in mortality or colon cancer with surveillance and treatment.

Clinical bottom line (level 2b)

  1. Annual surveillance and adequate treatment means patients with ulcerative colitis were not more likely to die or suffer colon cancer than the rest of the population.
  2. Around a third of patients with ulcerative colitis eventually had their colon removed.
Langholz et al: Gastroenterology 1992; 103: 1444-1451
Expires May 2003

The study

Retrospective cohort study with ?objective ?blinded outcomes, not adjusted for confounding factors, not validated in an independent set of patients.

Setting: university hospital, Denmark

1161 patients (aged ?, ?% male) ulcerative colitis
All patients had sulphasalazine or 5-ASA continued for at least 2 years beyond the presence of symptoms and typically longer. Topical or systemic glucocorticoids were used for flare-ups typically for 1 to 3 months. Patients who failed medical therapy had colectomy.

99.9% followed for from diagnosis to end 1987 (range 0 to 26 years: mean 12)
Outcomes studied:
  • colon cancer diagnosis from National Cancer Registry
  • deaths due to ulcerative colitis or its complications
  • colectomy after 25 years

    • All patients had yearly follow-up with endoscopy and radiography.

    The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    colon cancer from diagnosis to end 1987 (range 0 to 26 years: mean 12) 6/1161 0.5%
    (0.1% to 0.9%)
    deaths due to ulcerative colitis or its complications from diagnosis to end 1987 (range 0 to 26 years: mean 12) 26/1161 2.2%
    (1.4% to 3.1%)
    colectomy after 25 years from diagnosis to end 1987 (range 0 to 26 years: mean 12) / 32%
    (28% to 37%)

    prognostic factor for
    colon cancer     		time to outcome unadjusted RR
    (95% CI)
    ulcerative colitis from diagnosis to end 1987 (range 0 to 26 years: mean 12) 0.9
    (0.14 to 1.4)

    prognostic factor for
    deaths due to ulcerative colitis or its complications     		time to outcome unadjusted RR
    (95% CI)
    ulcerative colitis from diagnosis to end 1987 (range 0 to 26 years: mean 12) 1.1
    ( to )

    • deaths due to ulcerative colitis or its complications: RR: p<0.25

    Citation

    1. Langholz E, Munkholm P, Davidsen M, et al: Colorectal cancer risk and mortality in patients with ulcerative colitis. Gastroenterology 1992; 103: 1444-1451
    Search Terms: reference from review article
    Contributor: Chris Ball and Clare Wotton, October 2000
    Reviewer:

    Clinical Question.
    Patient ulcerative colitis
    Intervention or Exposure prevalence
    Outcome mortality, cancer, colon removed