Le Berre C¹, Ananthakrishnan AN², Danese S³, Singh S⁴, Peyrin-Biroulet L⁵. Clin Gastroenterol Hepatol. 2019 Jul 10. pii: S1542-3565(19)30738-4. doi: 10.1016/j.cgh.2019.07.005. [Epub ahead of print]

Author information

1 Inserm U954 and Department of Gastroenterology, Nancy University Hospital, Université de Lorraine, Vandoeuvre-lès-Nancy, France; Institut des Maladies de l'Appareil Digestif, Nantes University Hospital, Nantes, France.

2 Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA.

3 Department of Biomedical Sciences, Humanitas University, Milan, Italy; IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Center, Milan, Italy.

4 Division of Gastroenterology, University of California, San Diego, La Jolla, California.

5 Inserm U954 and Department of Gastroenterology, Nancy University Hospital, Université de Lorraine, Vandoeuvre-lès-Nancy, France. Electronic address: peyrinbiroulet@gmail.com.

Abstract

It is unclear whether ulcerative colitis (UC) is a progressive disease like Crohn's disease (CD). Patients with UC are often undertreated, because of the possibility of curative colectomy and the perception that the disease burden is lower than that of CD. We discuss findings from studies that aimed to determine whether UC and CD have the same disease burden and should be treated in the same intensive way. We discuss the similarities between CD and UC, including effects on quality of life, long-term complications, strictures, increased risk of cancer, pseudopolyps, functional abnormalities, and anorectal dysfunction. Contrary to the generally accepted idea, surgery cannot cure UC. Post-operative complications, especially pouchitis and fecal incontinence, affect more than one-third of patients. CD and UC each pose substantial economic burdens. Monitoring, treatments, and goals of therapy are similar for all inflammatory bowel diseases. Earlier initiation of disease-modifying drugs might reduce progression of UC and reduce its burden after surgery, although UC might not cause the irreversible damage observed in patients with CD.