Prognosis and treatment of chronic inflammatory bowel disease

Methods: Most studies of the prognosis of inflammatory bowel disease have not been population-based; they are retrospective reviews. Moreover, they lack uniform methods for assessment of outcome. The clinical course is difficult to predict and the prognosis has changed over the last decades as a result of progress in medical therapeutics and treatment principles and surgical methods.

Results: Patients suffering from Crohn's disease or ulcerative colitis will probably alternate between remission and relapse, with 10% having a relapse-free course after ten years, and only 1% having a continuously active course. There is a cumulative frequency of operation of 50-80% and of reoperation of 1/3 in Crohn's disease. In ulcerative colitis the overall probability of surgery is 1/3 for pancolitis and 10% for proctitis within five years of diagnosis, and the majority of patients are operated on within the first few years. Maintenance treatment with sulphasalazine (SASP) and 5-aminosalicylic acid (5-ASA) in ulcerative colitis has reduced relapse rates to about the half.

Conclusions: Changes in disease distribution in ulcerative colitis are part of the natural course of the disease. This should have implications for medical treatment strategies. Inflammatory bowel disease frequently requires potent medication with side-effects that limit patients' acceptance. Certain environmental factors as well as patient compliance are thought to determine the clinical outcome in ulcerative colitis and Crohn's disease.