Prognosis
Overall mortality does not appear to be increased in patients with UC compared with the general population. However, one population-based study carried out in Manitoba found an increased risk of mortality among UC patients within the first year from diagnosis when compared with matched controls.[124] An increase in mortality may also be observed in older patients with UC, and in patients with UC who develop complications (e.g., toxic megacolon, shock, malnutrition, or anaemia). There is also evidence to suggest that patients with UC who undergo any form of surgical intervention have an increased mortality.[124]
Colonic adenocarcinoma develops in 3% to 5% of patients. Benign stricture may rarely cause intestinal obstruction.[125][126] One population-based study found that Clostridium difficile diagnosis worsens the prognosis of newly diagnosed patients with UC by increasing the risk of colectomy, postoperative complications, and death.[127]
Pregnancy does not affect the course of UC. However, under-treatment of active disease may adversely affect the pregnancy. In active disease, medications should therefore be given as if the patient were not pregnant (with the proviso that drugs such as methotrexate and metronidazole, which are contraindicated in pregnancy, should be avoided). Patients with quiescent UC have the same fertility rate and risk of complications during pregnancy as the general population. Nutrition during the first trimester of pregnancy is crucial.[69]
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