An experience of ulcerative colitis. 3. Long term outcome.

The long-term prognosis of ulcerative colitis has been examined in a retrospective study of 399 patients, which represents the total experience of a specialized unit over a period of 18 years. Progress of the severity of colitis has been followed over four attacks in an individual. The change in the radiologically determined extent of involvement has been assessed from these attacks. The outcome of each attack has been related to the severity of that attack and to the severity of the first referred attack. Using life table methods, longterm survival rates have been calculated. Patients who did not have surgery in the first referred attack experienced a long-term fatality rate which was little worse than that of the general population. On the other hand, patients undergoing surgery in the first referred attack had a higher long-term mortality. The “patient-year” concept has been used to assess the annual mortality, relapse, and hospital admission rates for patients surviving the first referred attack without surgery. A relapse rate of 27% per annum was experienced and varied little with the severity of the first referred attack. Patients with normal barium enema had a relapse rate of 33.6% per year but the lowest hospital admission rates. Patients moderately ill in the first referred attack had a subsequent annual mortality of 2.4% per year which was higher than patients who were severely ill during this attack. Elderly patients with colitis who survived the first referred attack without surgery suffered no greater mortality than elderly subjects without colitis, but younger patients fared considerably worse.