Department of Internal Medicine F, Gastroenterology Section, Gentofte Hospital, N. Andersensvej 65, DK 2900 Hellerup, Denmark.
Therap Adv Gastroenterol. 2010 Mar;3(2):77-86. doi: 10.1177/1756283X10361304.
The description of the prognosis of inflammatory bowel disease (IBD) is based on systematic follow-up of population-based cohorts. A steady increase in incidence of IBD has occurred. The distribution of ulcerative colitis (UC) is fairly uniform with a preponderance of left-sided disease. One-third of Crohn's disease (CD) patients present with colonic disease, one-third with ileocolonic disease and one-third with small bowel disease. IBD is associated with extra-intestinal manifestations (EIMs) in up to 36% of patients. Uveitis and episcleritis are the most common. The cumulative probability of a relapsing course in UC is 90% after 25 years. In CD disease behaviour varies substantially with time. At diagnosis behaviour is inflammatory in 70% of patients. At follow-up there is a change to either stricturing or penetrating disease. Most patients with CD will eventually require surgery. Risk factors for CD recurrence after surgery include penetrating/fistulizing disease behaviour, young age, short duration of disease before first surgery and ileocolonic disease. The incidence of colorectal cancer (CRC) in UC seems to be decreasing. The risk of CRC in CD seems to be equivalent to the risk in UC. Patients with small bowel CD are also at increased risk of small bowel adenocarcinoma. CD is associated with a mortality rate 20-70% higher than expected, whereas mortality in UC is equivalent to that of the general population. The improved prognosis of IBD, especially UC, could be due to a chemopreventive effect of the medications used. Further studies are needed to develop the best strategy for the reduction of mortality and cancer risk in IBD.
炎症性肠病（IBD）的预后描述是基于基于人群的队列的系统随访。IBD 的发病率持续上升。溃疡性结肠炎（UC）的分布相当均匀，左侧疾病居多。三分之一的克罗恩病（CD）患者存在结肠疾病，三分之一存在回结肠疾病，三分之一存在小肠疾病。IBD 与高达 36%的患者的肠外表现（EIMs）相关。葡萄膜炎和表层巩膜炎最常见。UC 反复发作的累积概率在 25 年后为 90%。CD 的疾病行为随时间而显著变化。在诊断时，70%的患者的行为为炎症性。随访时，会出现狭窄或穿透性疾病。大多数 CD 患者最终需要手术。手术后 CD 复发的危险因素包括穿透/瘘管性疾病行为、年轻、首次手术前疾病持续时间短和回结肠疾病。UC 中的结直肠癌（CRC）的发病率似乎在下降。CD 中 CRC 的风险似乎与 UC 中的风险相当。患有小肠 CD 的患者也有增加小肠腺癌的风险。CD 的死亡率比预期高 20-70%，而 UC 的死亡率与普通人群相当。IBD 的预后改善，尤其是 UC，可以归因于所用药物的化学预防作用。需要进一步研究以制定降低 IBD 死亡率和癌症风险的最佳策略。
