Ulcerative Colitis Life Expectancy and Cancer Surveillance
Mortality Data
- Population-based cohorts: **life expectancy near normal** (within 1–2 years of general population).
- Standardized mortality ratio (SMR) ~1.1–1.5; excess mortality from colorectal cancer, pulmonary embolism, primary sclerosing cholangitis (PSC).
- Colectomy eliminates CRC risk but not PSC/cholangiocarcinoma risk.
Colorectal Cancer (CRC) Risk
- Extent/duration dependent: pancolitis >8–10 years → risk rises 0.5–1%/year.
- Additional risk factors: PSC, family history, persistent inflammation, post-inflammatory polyps.
Surveillance Guidelines (SCENIC/ACG)
- Begin 8 years after pancolitis diagnosis, 12–15 years after left-sided.
- Chromoendoscopy with targeted biopsies (preferred) or high-definition white light + random biopsies.
- Intervals: 1–3 years based on risk stratification.
- Dysplasia management: endoscopic resection (if visible, resectable) or colectomy (invisible/high-grade/multifocal).
Quality of Life
Biologics (anti-TNF, vedolizumab, ustekinumab, JAK inhibitors) achieve mucosal healing → reduce hospitalization, surgery, disability.
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