Complications

• ↑ Risk of cancer (see ”Long-term management” in “Treatment” for screening protocol)

  • Risk increases with duration and/or extent of disease (e.g., pancolitis).

  • Colorectal carcinoma risk is not significantly increased in patients with mild ulcerative colitis.

• Toxic megacolon

• Fulminant colitis: severe bowel inflammation that typically causes > 10 stools per day, lower gastrointestinal bleeding, abdominal pain, and abdominal distention

• Gastrointestinal bleeding (both acute and chronic)

• Perforation → peritonitis (see “Gastrointestinal perforation”)

• Colonic stricture

• Amyloidosis

Fertility and preconception counseling

• Fertility is not affected in women with IBD in remission and no history of abdominal surgery.

• Women with active disease have decreased fertility rates.

• Pharmacological therapy for IBD does not impact fertility.

• Active disease at conception increases the risk of persistently active disease during gestation.

• Active disease is associated with an increased risk of preterm birth and low birth weight.

• Patients who wish to conceive should be on appropriate pharmacological therapy to maintain disease remission.

• With the exception of methotrexate, all other treatments can be continued at conception.

Disease management during pregnancy

• Most medications used in the treatment of IBD are considered safe during pregnancy.

• Corticosteroids are indicated for disease flares but should be avoided as maintenance therapy because of the increased risk of gestational diabetes, preterm birth, and low birth weight.

• 5-ASA, 5-ASA derivatives, immunomodulators, and biopharmaceuticals can be used during pregnancy.

• Monotherapy is preferred for maintenance treatment to reduce the risk of adverse effects.

On average, the life expectancy of patients with ulcerative colitis is normal.