Clinical alert
Ulcerative colitis extent varies with time but endoscopic appearances may be deceptive
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Patients with ulcerative colitis need to be able to obtain reliable advice about their likely prognosis and cancer risk. Up until now this has been difficult because the literature is imprecise. Studies determining progression over time or cancer risk have often been based on disease extent as determined by barium examinations. Moreover, some patients may have very severe distal disease while others may have very mild extensive disease. As has often been the case, a meticulous and very extensive Scandinavian study has helped to clarify the situation.
Moum et al have prospectively compared
colonoscopic and histological findings at diagnosis and after 12-23
months of follow up in 384 cases of ulcerative colitis from a sample
population of 496.1 Some of the findings are predictable
but useful nevertheless. Extensive colitis at diagnosis may become less
extensive while distal disease may become more extensive. Significant
change in extent or reversion to normal
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