Comment

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 endoscopic or histological appearances occurred in more than half of the patients by the median 14 month follow up. This report supports the findings of a smaller study2 which also suggested that change in colonoscopic extent of ulcerative colitis with time was the norm rather than the exception. This makes …