Early onset of ulcerative colitis:: Long-term follow-up with special reference to colorectal cancer and primary sclerosing cholangitis

Objectives: 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. Patients and Methods: 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. Results: 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. Conclusions: 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.