I have ulcerative colitis. Can flares raise colon cancer risk?

Question

Hello doctor,

I have had UC for three years, and my latest colonoscopy shows moderate inflammation with ulcers in the sigmoid colon. My fecal calprotectin level is 620 µg/g, and my CRP level is 40 mg/L.

I am on Mesalamine, but still getting bloody stools and abdominal pain. My concerns are -

Does this mean I need to switch to biologics, such as Infliximab?
Are there risks of colon cancer if flare-ups continue often?
Should I avoid dairy and spicy foods, or are specific diet plans more effective?
Also, how often should I get colonoscopies to monitor disease progression properly?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

I am sorry to hear you are still struggling with ulcerative colitis despite being on Mesalamine. Your symptoms, combined with your colonoscopy findings and elevated calprotectin (620) and CRP (C-reactive protein) (40), are clear signs that your current treatment is not enough to control the inflammation.

Here are my suggestions to your concerns -

Switching to biologics is the logical next step. Your disease is moderately active and not responding to first-line therapy. Infliximab or other biologics are highly effective for achieving and maintaining remission in this situation. We need to act to get this inflammation under control.
Ongoing, uncontrolled inflammation does increase long-term cancer risk. This is precisely why getting into deep remission with effective medication like biologics is so important; it reduces that risk back to near-normal levels.
While dairy and spicy foods can irritate an already inflamed gut, they do not cause the inflammation. A low-FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) or low-residue diet during flares can help manage symptoms, but it is not a substitute for effective medical treatment to heal the ulcers.
With active disease, annual colonoscopies are typical until sustained remission is achieved. Once in deep remission for two to three years, the interval can be extended.

I hope this helps.

Thank you and take care.

Regards.