Natural history

1
Surgery in ulcerative colitis

• Natural history
• Growth and development
• Severe attack - hospitalization - 15
• Surgery - 25-40
• Emergency

2
Surgery in ulcerative colitis

• Drugs
• Palliative
• Life long
• Side effects
• Costs
• Repeated hospitalisation
• Emergency surgery

3
Surgery in ulcerative colitis

• Mortality of surgery
• Elective almost nil
• Cleveland, Mayo, St Marks
• Emergency 5
• St Marks

4
Surgery in ulcerative colitis

• Causes of death
• UC does not increase the mortality rate
• Patients with UC die of
• Cancer
• Complications of disease
• Complications of treatment

5
Surgery in ulcerative colitis

• Cancer in ulcerative colitis
• 5 will develop cancer
• 1973-93 (n801)
• Cumulative risk at 20 years 5
• at 25 years 10
• One out of six after 30 years
• One out of three after 35 years

Wandall. Sc J Gastr 2000
6
Surgery in ulcerative colitis

• Indications for elective surgery
• Young
• Pancolitis
• Stricture, dysplasia, cancer
• Refractory
• Steroid dependent
• Non-colonic indications (PSC)

7
Surgery in ulcerative colitis
Options
Drugs are the first option. Surgery is also an
option. The only curative option.