A 35-year-old man comes to the office for follow-up of ulcerative colitis. The condition was diagnosed 8 years ago and, at that time, involved the entire colon. The patient started taking mesalamine and has been asymptomatic ever since. Medical history is otherwise unremarkable. Family history is negative for inflammatory bowel disease and cancer. Physical examination is normal. Which of the following is the most appropriate management at this time?

Question

A 35-year-old man comes to the office for follow-up of ulcerative colitis.  The condition was diagnosed 8 years ago and, at that time, involved the entire colon.  The patient started taking mesalamine and has been asymptomatic ever since.  Medical history is otherwise unremarkable.  Family history is negative for inflammatory bowel disease and cancer.  Physical examination is normal.  Which of the following is the most appropriate management at this time?

Quizplus · Accepted Answer

11ec25c8_d3f4_6969_bc81_add12f3cf5d4_MD0003_00 Patients with ulcerative colitis (UC) are at increased risk for colorectal cancer (CRC), and the risk is proportionate to the duration and extent of disease. CRC in UC develops from dysplastic lesions, which can arise in any part of the colon that is currently or was previously inflamed. Even this patient, whose disease initially involved the entire colon but is now well controlled with mesalamine, is at increased risk for CRC. The risk is also likely elevated in patients who have Crohn disease with extensive colon involvement (Crohn colitis). Patients with UC should undergo surveillance colonoscopy beginning 8 years after initial diagnosis; some experts begin surveillance at 10 years in patients with limited disease involving less than one-third of the colon. Colonoscopy should then be repeated every 1-3 years thereafter. Any polyps should be removed, and mucosal biopsies obtained from any abnormal-appearing regions as well as from random sites throughout the colon. (Choice B) A screening colonoscopy interval of 5 years is appropriate for patients without inflammatory bowel disease who have a family history of CRC in a first-degree relative who had CRC before age 60. It also is appropriate for patients who have 2 or more first-degree relatives with CRC at any age. However, this screening interval is too long for a UC patient with extensive colonic involvement. (Choice C) Prophylactic colectomy is often considered for UC patients with high-grade dysplasia found on colonoscopy, as well as for some patients with hereditary colorectal cancer syndromes (eg, familial adenomatous polyposis). It is unnecessary for patients with uncomplicated UC. (Choices D and E) Colon screening for average-risk individuals should begin at age 45, but patients with UC are at increased risk. This patient has long-standing UC with extensive colonic involvement; CRC screening with colonoscopy is indicated now, regardless of disease control. Educational objective: Patients with ulcerative colitis are at increased risk for colorectal cancer, and the risk is proportionate to the duration and extent of disease. Screening colonoscopy should be offered to patients with long-standing ulcerative colitis beginning 8 years after diagnosis and every 1-3 years thereafter. References: AGA medical position statement on the diagnosis and management of colorectal neoplasia in inflammatory bowel disease. (http://www.ncbi.nlm.nih.gov/pubmed/20141808)

A 35-Year-Old Man Comes to the Office for Follow-Up of Ulcerative