Prognosis and prognostic factors in inflammatory bowel disease

The chance of normal survival for patients with inflammatory bowel disease is generally good. There may be a small excess mortality for those with Crohn's disease; however recent studies do not confirm this trend. For those with ulcerative colitis, there may be an excess mortality in the first two years after diagnosis, especially in those who undergo surgery. The necessity for an operation varies, but at least 50% of patients with Crohn's disease will be an operation in the first 10 years; whereas only about 20% of patients with ulcerative colitis will require a colectomy. Most patients with inflammatory bowel disease are able to lead a normal life and are not disabled by their disease. The prognosis in the elderly is usually good; however there is an increased mortality over younger patients, which is probably due to the presence of coexistent disease. Children also have a slightly higher mortality; this may be due to the relative frequency of a particularly extensive disease and the development of colorectal cancer. Growth retardation occurs in up to one-third of children with Crohn's disease, but it may be resolved if remission can be obtained. Pregnancy has not been shown to have an impact on inflammatory bowel disease, but its onset during pregnancy confers a significant risk for both mother and child. Extensive involvement is a poor prognosis factor in both diseases; conversely, isolated small bowel Crohn's disease and ulcerative proctitis carry particularly good prognoses. A short clinical history, fistulae or abscesses at presentation probably represent an aggressive form of Crohn's disease. Hypoalbuminemia, anemia and raised inflammatory markers are laboratory markers which suggest a worse prognosis in the short and possibly long-term.