BACKGROUND AND AIMS Controversy surrounds the risk of colorectal cancer (CRC) in ulcerative colitis (UC). Many studies have investigated this risk and reported widely varying rates. METHODS A literature search using Medline with the explosion of references identified 194 studies. Of these, 116 met our inclusion criteria from which the number of patients and cancers detected could be extracted. Overall pooled estimates, with 95% confidence intervals (CI), of cancer prevalence and incidence were obtained using a random effects model on either the log odds or log incidence scale, as appropriate. RESULTS The overall prevalence of CRC in any UC patient, based on 116 studies, was estimated to be 3.7% (95% CI 3.2–4.2%). Of the 116 studies, 41 reported colitis duration. From these the overall incidence rate was 3/1000 person years duration (pyd), (95% CI 2/1000 to 4/1000). The overall incidence rate for any child was 6/1000 pyd (95% CI 3/1000 to 13/1000). Of the 41 studies, 19 reported results stratified into 10 year intervals of disease duration. For the first 10 years the incidence rate was 2/1000 pyd (95% CI 1/1000 to 2/1000), for the second decade the incidence rate was estimated to be 7/1000 pyd (95% CI 4/1000 to 12/1000), and in the third decade the incidence rate was 12/1000 pyd (95% CI 7/1000 to 19/1000). These incidence rates corresponded to cumulative probabilities of 2% by 10 years, 8% by 20 years, and 18% by 30 years. The worldwide cancer incidence rates varied geographically, being 5/1000 pyd in the USA, 4/1000 pyd in the UK, and 2/1000 pyd in Scandinavia and other countries. Over time the cancer risk has increased since 1955 but this finding was not significant (p=0.8). CONCLUSIONS Using new meta-analysis techniques we determined the risk of CRC in UC by decade of disease and defined the risk in pancolitics and children. We found a non-significant increase in risk over time and estimated how risk varies with geography.

https://gut.bmj.com/content/gutjnl/48/4/526.full.pdf

The risk of colorectal cancer in ulcerative colitis: a meta-analysis

https://www.gastrojournal.org/article/0016-5085(78)90859-4/pdf

Growth retardation in inflammatory bowel disease

Severe Colitis in Children and Adolescents: Diagnosis, Course, and Treatment

A regional patient group comprising 783 patients with ulcerative colitis (UC) and 185 patients with Crohn's disease (CD) diagnosed during the period 1960 to 1978 was analysed in accordance with clinical appearance at diagnosis. Of the UC patients, 16% showed total colonic involvement, 41% substantial colonic involvement, and 41% rectal affection only. The disease extent was positively correlated to the degree of activity but not to the age or sex of the patients. 70% of the patients were in moderately or very active stage of disease, 28% in slightly active stage, and 2% inactive at the time of diagnosis. 43% of the patients had experienced weight loss, 27% fever, and 53% abdominal pains in their initial attack of the disease. Immunological manifestations were present in 13%. Of the CD patients 31% had small-bowel localization only, 28% large bowel only, 36% ileocolonic affection, and 5% other combinations. Patients with ileal involvement were significantly younger than patients with colonic involvement. T...

Clinical appearance at diagnosis of ulcerative colitis and Crohn's disease in a regional patient group.

Background: Most incidence studies of ulcerative colitis (UC) and Crohn disease (CD) have dealt with adults and there are have been few population-based prospective studies of the incidence of inflammatory bowel disease (IBD) in children. The aim of this study was to determine the incidence after re-evaluation of the diagnosis of UC and CD in childhood and adolescence in a prospective population-based survey. Methods: From 1 January 1990 to 31 December 1993, all newly diagnosed patients with UC and CD under the age of 16 years were registered. On 1 January 1992 there were 174,482 children in the study population. The diagnosis was based on internationally accepted criteria and all clinical data were reviewed by two gastroenterologists independently of each other. All patients were subjected to a second evaluation 1 year after inclusion in the study. Patients initially diagnosed as indeterminate colitis (IND) were also reassessed. Results: A total of 14 cases of UC, 13 cases of CD and 2 cases of IND were r...

Incidence of Inflammatory Bowel Disease in Children in Southeastern Norway: A Prospective Population-based Study 1990-94

This report reviews the illness of 43 patients who had developed symptoms of chronic ulcerative colitis during their childhood or teenage years (1953–1966). The clinical picture is similar to that observed in adults, although these patients appear more ill and disabled by their disease. When first seen, 71% of the patients had total colon involvement, and 65% had complications of the disease. At follow-up, 6 died, 2 had colectomies, 27 are under medical treatment, but only 15 remain relatively symptom-free. Nine are alive after surgery. One patient's status is unknown. In general, it is difficult to control ulcerative colitis that begins when the patient is young; it is associated with a high rate of mortality and morbidity. Earlier consideration should be given to surgical treatment when patients respond poorly or incompletely to medical treatment.

Lloyd Sampson

Papers

Chronic ulcerative colitis beginning in children and teenagers. A review of 43 patients.

Chronic Ulcerative Colitis Beginning in Children and Teenagers.