Ulcerative Colitis

The prognosis of patients with ulcerative colitis is usually characterized by repeated flares

and remissions. A rapidly progressive initial attack results in serious complications in about

10% of patients. Complete recovery after a single attack may occur in another 10% of

patients, some of whom may actually have had an acute undetected infection rather than true

ulcerative colitis. The probability that a patient with clinically inactive disease will remain in

remission the following year is 80 to 90%. By comparison, patients with clinically active

disease have a 70% probability of relapse during the following year.

Patients who present with ulcerative proctitis have the best overall prognosis, and only about

5% of patients with proctitis will require colectomy over a lifetime. Severe complications are

very uncommon, but the disease will spread more proximally in the colon in approximately

10% to 30% of patients. Ulcerative colitis–related mortality has decreased substantially since

the introduction of corticosteroids, and recent studies suggest that long-term survival rates for

patients with ulcerative colitis are similar to those of the general population.

Crohn’s Disease

Crohn’s disease classically waxes and wanes. A patient with clinically active Crohn’s disease

has a 70 to 80% chance of having active disease in the subsequent year, whereas 80% of

patients in remission will remain so over the following year. Over the course of a 4-year

period, about 25% of patients will have persistently active disease after diagnosis, about 25%

will remain in remission, and 50% will have a fluctuating course with years of remission and

years with clinically active disease. Approximately 75 to 80% of all patients with luminal and

fistulizing Crohn’s disease will require surgical intervention for their disease, with

approximately 50% of them requiring surgery within 6 months of diagnosis. The rate for a

second surgery for luminal Crohn’s disease ranges from 25 to 38% within 5 years, and 40 to
70% will need reoperation by 15 years. Patients with Crohn’s disease have an increased

mortality rate, about 1.3 to 1.5 times higher than the general population, unrelated to whether

they have small intestine or large intestine involvement, or both. This excess mortality, which

is most notable in the first few years after diagnosis, is most commonly related to

complications of Crohn’s disease (e.g., colorectal cancer, shock, volume depletion,

protein-calorie malnutrition, and anemia). Whether aggressive use of immunomodulators and

biologic therapy will alter themnatural course of disease is unknown.