Prognosis in ulcerative colitis.

In unselected patient populations with ulcerative colitis the overall prognosis is good and has improved over the years. There is still an appreciable excess mortality, however, particularly during the first years after diagnosis and it tends to increase with duration of disease. Patients with severe attacks, total colitis, and high age at diagnosis are particularly at risk. The disease runs an inactive or intermittent course in the majority of patients, although up to one fifth of the patients have a progress of the original extent of the colitis. Worldwide, there has been a time trend of decreased mortality possibly affecting younger patients in particular. Complications of the acute attack with or without surgery, liver disease, and colon cancer account for the major part of the colitis-related deaths whereas the mortality pattern in other respects does not differ significantly from that of the general population. The colon cancer incidence seems lower than previously reported but still accounts for approximately one tenth of all deaths. If this figure can be improved with cancer surveillance and prophylactic colectomy seems probable but remains to be shown. Pregnancy, if planned, should be encouraged when the patient is in remission although the disease or its standard treatment does not seem to dangerously affect the patient, fetus, or the newborn infant. Surgical and medical treatment probably accounts for most of the improvement in prognosis seen over the years. The postoperative mortality has been reduced, especially in series where new surgical procedures have been used. A high frequency of major postoperative complications still remains a challenge for improvement. The medical intensive treatment of the acute attack has contributed to the improved prognosis. If compliance is good, the sulfasalazine prophylaxis may be one of the explanations to the change into a milder disease pattern that has been observed recently. Finally, and most important, a majority of patients sustain a normal life with full working capacity. Those who have surgery adapt well, particularly when a continence-saving procedure is used. The sexual function follows the improvement although the patient's need for support and counseling should not be underestimated.