Rettocolite ulcerosa e displasia: quale monitoraggio nei pazienti a rischio?=Ulcerative colitis and dysplasia: Which monitoring in risk patients?

First study, by Bargen, based on relations between cancer and U.C. dates back to 1928; since then it is currently common knowledge that patients with U.C. have an incremented risk to develop cancer of the colon compared to the average population. At present it seems that risk is related to the duration and the extension of disease and only partially to the activity degree. The increase of the risk is to be considered not before seven years since the outbreak of the disease. The increased risk is particularly high in patients with pancolitis. The objective of this study is to verify the effectiveness of the colonoscopic surveillance program to which our patients have been submitted, the above in order to establish a long range management program of patients themselves. 148 patients affected by U.C. have been engaged, 90 males and 58 females, average age 40 years. The following factors have been evaluated for each patients initially and every six month: family and pathological remote anamnesis, age of disease's beginning, histological diagnosis, extension, activity clinical indexes, endoscopic aspect and carried out therapies. Within the considered sample the average duration of disease, since the first histological diagnosis, was 71.4 months; 40 of them presented a duration above 84 months; the extension of the disease involved left colon in 114 cases (77%) and whole colon in 34 cases (23%). 14 patients presented dysplasia, out of them we observed 10 slight intensity case and 4 severe; it must be underline that the evidence of dysplasia has never been verify at the first endoscopical exam but only in following controls. Patients with dysplasia were 51 years old on average; the average duration of the disease was 124 months. Dysplasia occurred in 25% of subjects with an increased risk, that is in patients with disease duration above seven years. Malignant degeneration was found in 4 out of 148 cases, 2 males and 2 females, average period between diagnosis and disease degeneration was 17 years. From the analysis of results we deduce the following conclusion: the utility of making colonoscopic management for high risk patients, continuing within even after first negative controls; in no risk population, it would be better to have a clinical approach with colonoscopic exam only if there's an alteration of symptomatology.