Inflammatory bowel disease : risk factors for adverse outcomes, and preventive measures

The purpose of this thesis was to identify risk factors for malignant transformation, survival, pregnancy outcomes and complications Further to assess the impact of surveillance colonoscopy and pharmacotherapy as a preventive measures in patients inflammatory bowel disease (IBD).

As sources of information we have utilized following population based cohorts3112 patients with ulcerative colitis diagnosis within the Uppsala Health Care Region from 1965 to 1983, 125 patients with primary sclerosing cholangitis collected from7 different hospitals in central of Sweden from 1964 to 1991, 239773 single births in Sweden from 1991 to 1992 and 4664 patients with ulcerative colitis diagnosis within the Uppsala Health Care Region and Stockholm County between year 1955 to 1984. Long-term treatment with sulphasalazine (>3 months) decreases the risk for colorectal cancer in patients with ulcerative colitis with approximately 60%. This protective effect was practically unchanged after adjustment for for potential confounders.

Patients with primary sclerosing cholangitis(PSC) have an substantially decreased survival which is mostly pronounced among patients without IBD and substantial cumulative risk of cholangiocarcinoma. IBN patients with PSC have an increased cumulative risk for colorectal cancer compared to other IBD patients. A diagnosis of inflammatory bowel disease is associated with an increased risk for adverse pregnancy outcomes such as preterm birth, low birth weight and small for gestational age as well as an increased risk for Cesarean section. Surveillance colonoscopy seems to protect against death in colorectal cancer inpatients with ulcerative colitis.