The Evolution of the Management of Dysplasia in Ulcerative Colitis

With modern medicine and a better understanding of the ulcerative colitis disease process, there have been many changes in how we manage ulcerative colitis-related dysplasia over the past 20 years. One of the biggest concerns for these patients, given the inflammatory nature of their disease, is the progression from chronic inflammation to cancer. Patients with ulcerative colitis have about a 2.4-fold increased risk of developing colorectal cancer compared to the general population, which is concerning since colorectal cancer is the 2nd leading cause of cancer-related deaths in the United States. Traditionally, surgery was the preferred treatment for ulcerative colitis patients with dysplasia, but now, with advances in surveillance such as high-definition colonoscopy and chromoendoscopy, the management approach is more nuanced. Understanding the risk for different individuals within this patient population is key to comprehensive and personalized care management. In this review article, we will explore risk factors, surveillance methods, and classification.