Lindberg Jan, Stenling Roger, Palmqvist Richard, Rutegård Jörgen
Department of Surgery, Ornsköldsvik Hospital, Ornsköldsvik, Sweden.
J Pediatr Gastroenterol Nutr. 2008 May;46(5):534-8. doi: 10.1097/MPG.0b013e31815a98ef.
Ulcerative colitis (UC) is associated with an increased risk of colorectal cancer (CRC) and primary sclerosing cholangitis (PSC). The onset of UC at a young age has been considered a specific risk factor for CRC. This study reports the outcome with respect to DNA aneuploidy, dysplasia, CRC, and PSC in a cohort of patients with early-onset UC from a defined catchment area who were followed up for 45 years.
The study period was from 1961 through 2005. In all, 46 children and adolescents, ages 18 or younger from our catchment area, were affected with UC during this time. Data were collected from our colonoscopic surveillance program and other medical records in the same hospital.
The incidence rate of UC was 1.6 children or adolescents per 100,000 inhabitants per year. The onset of disease was at age 14 years (mean and median), and the observed duration of disease was 0 to 44 years. Five patients died, 3 of them of intercurrent disease. CRC developed in 1 patient, and no death caused by this disease was observed. PSC was diagnosed in 4 patients, in all of whom the onset of UC occurred before age 15.
The earlier reports of increased risk of CRC in patients with early-onset UC was not seen in this study. This could be due to a high frequency of surgery together with a well-functioning surveillance program with excellent compliance. The recommendation of surgery in cases of high-grade dysplasia or repeated findings of low-grade dysplasia seems to be effective in the attempt to minimize the risk for CRC. We observed a rather high incidence of PSC, which may indicate that more attention should be paid to a search for this diagnosis in patients with early-onset UC.
溃疡性结肠炎（UC）与结直肠癌（CRC）及原发性硬化性胆管炎（PSC）风险增加相关。年轻时发病的UC被认为是CRC的一个特定风险因素。本研究报告了来自特定集水区的早发性UC患者队列在长达45年随访期间的DNA非整倍体、发育异常、CRC和PSC情况。
研究时间段为1961年至2005年。在此期间，我们集水区内共有46名18岁及以下的儿童和青少年患UC。数据收集自我们的结肠镜监测项目及同一家医院的其他医疗记录。
UC发病率为每年每10万居民中有1.6名儿童或青少年。发病年龄为14岁（均值和中位数），观察到的病程为0至44年。5例患者死亡，其中3例死于并发疾病。1例患者发生CRC，未观察到由此病导致的死亡。4例患者被诊断为PSC，所有这些患者的UC发病均在15岁之前。
本研究未发现早发性UC患者CRC风险增加的早期报告中所提及的情况。这可能是由于手术频率高以及有一个运作良好且依从性极佳的监测项目。对于高级别发育异常或反复出现低级别发育异常的病例推荐手术，这在试图将CRC风险降至最低方面似乎是有效的。我们观察到PSC的发病率相当高，这可能表明对于早发性UC患者应更关注对此病的筛查。
