gi16 - shuun

[ArchivalUser]

A 35-year-old man with a 10-year history of ulcerative colitis involving the entire colon comes for a follow-up office visit. A small bowel follow-through radiographic series obtained at the time of diagnosis was normal.

The patient is doing well on mesalamine maintenance therapy. He has only occasional diarrhea and bleeding and has rarely required corticosteroids. A colonoscopic examination with biopsies 1 month ago showed changes of chronic ulcerative colitis but no signs of dysplasia.

Which of the following surveillance options is most appropriate for this patient?

A Repeat colonoscopy with biopsies starting at age 50; then repeat examination every 5 years
B Repeat colonoscopy with biopsies now; then repeat examination every 5 years
C Repeat colonoscopy with biopsies now; then repeat examination every 1 to 2 years
D Colonoscopy with biopsies only if the patient has symptoms refractory to medical therapy
E Barium enema examination or virtual colonoscopy (CT colonography) now; repeat studies every 1 to 2 years

[ArchivalUser]

b.

[ArchivalUser]

dd

[ArchivalUser]

ans-a

[ArchivalUser]

C is rt ans

[ArchivalUser]

C is rt ans.

Chronic inflammatory bowel disease, such as ulcerative colitis, is a risk factor for the development of colorectal cancer. The risk increases with the duration and extent of the disease, early age of onset, and presence of primary sclerosing cholangitis. Patients with inflammatory bowel disease should regularly undergo surveillance colonoscopy with biopsies obtained from throughout the colon to detect dysplasia, which is a marker for possible colorectal cancer. Current guidelines recommend colonoscopy every 1 to 2 years for patients with pancolitis of 10 years or more duration.