Medical Care

Ulcerative Colitis: Surgery May Be Better than Drugs

Patients over 50 who have ulcerative colitis live longer if they undergo surgery rather than taking drugs, according to a new study from the Perelman School of Medicine at the University of Pennsylvania.

The finding was published in the Annals of Internal Medicine.

“Most physicians opt to treat [ulcerative colitis] with medications, as opposed to surgery,” said the study’s lead author Meenakshi Bewtra, MD, PhD, MPH, assistant professor of Medicine and Epidemiology at Penn. “This new finding highlights a potential unrecognized advantage of a surgical approach to the disease.”

Ulcerative colitis is a type of inflammatory bowel disease characterized by inflammation in the colon. It can cause abdominal discomfort, bleeding, and diarrhea. As many as 700,000 Americans are affected, according to the Crohn’s & Colitis Foundation of America.

The conventional view of UC treatment is that surgery is the last resort. But, according to a news release from the university, medical treatments involving immunosuppressant and steroid drugs, come with significant side effects, and can increase the risk of infection and some cancers. And these medications effectively control the disease in less than 50 percent of patients.

In a retrospective study, Bewtra and colleagues analyzed data from the Centers for Medicare and Medicaid Services (CMS) to examine whether patients with advanced UC pursuing elective colectomy – in which surgeons remove the patient’s colon — had improved survival compared to similar patients pursuing chronic drug therapy. The researchers defined advanced UC as those patients who had had at least one hospitalization for UC, had two or more corticosteroid prescriptions within a 90-day period, or had any prescription for immunosuppressant therapy.

The study identified 32,833 UC patients 18 years of age and older who had at least six months of Medicare/Medicaid eligibility and who fit the inclusion criteria. Of these, 830 underwent elective colectomy and the remaining 32,003 were managed on drug therapies.

“With this new knowledge, physicians should be empowered to begin a dialogue about surgery earlier in their patients’ course of treatment,” Bewtra said. “Many patients are afraid of surgical therapy for UC. This study should help them to understand that the benefits of surgery may extend beyond just reducing the symptoms of uncontrolled UC.”


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