Surgery May Beat Drugs for Ulcerative Colitis: Study

Patients 50 and up with advanced disease benefited the most

Monday, July 13, 2015

MONDAY, July 13, 2015 (HealthDay News) -- Surgery may extend the lives of older adults with the inflammatory bowel disease ulcerative colitis, new research suggests.

A study of thousands of adults with the condition compared results of surgery to those of long-term drug treatment. It found that surgery's survival benefit was greatest for those 50 and older who had advanced disease.

"Surgery has always been an option," said study leader Dr. Meenakshi Bewtra, but many experts look at it as a last resort.

Bewtra, assistant professor of medicine and epidemiology at the University of Pennsylvania Perelman School of Medicine, used data from Medicare and Medicaid for the study. She and her colleagues followed 830 patients who had elective surgery -- known as colectomy -- and more than 7,500 who took medicine to manage the condition.

Surgery involves removal of the colon, sometimes followed by additional surgery to reconnect the small intestine to the rectum, Bewtra said. If that follow-up surgery is not done, the patient has an ostomy bag to collect wastes, she said.

Over five years, surgery was linked with a 33 percent reduced risk of death compared to medication, Bewtra's team found. The operations were performed between 2000 and 2011.

"We always thought those older [patients] had an increased risk of death due to complications from the surgery," she said. "This is not the case."

The study was published July 13 in Annals of Internal Medicine.

Ulcerative colitis affects up to 700,000 Americans, according to the Crohn's & Colitis Foundation of America. Inflammation causes irritation in the lining of the colon and large intestine. This can result in diarrhea, cramping, abdominal pain and rectal bleeding.

As symptoms worsen, patients may need more medicines, including corticosteroids, which are linked with an increased risk of infection and death. Medication is also associated with a high relapse rate, the researchers said.

Bottom line? The study suggests that surgery should be considered earlier in the course of the disease, Bewtra said, not viewed as a last resort.

"If you have ulcerative colitis and especially if you have failed medical [drug] therapies in the past, have long-standing disease, have been hospitalized, been on corticosteroids -- talk to your physician about elective surgery," Bewtra said. The surgery is typically covered by Medicare and other health plans, she added.

The decision to opt for surgery is individual, said Dr. David B. Sachar, a gastroenterologist and professor of medicine at Icahn School of Medicine at Mount Sinai in New York City.

"Wonderful new medicines often postpone, sometimes completely obviate the need for surgery," said Sachar, author of an editorial accompanying the study.

"But too often we, as gastroenterologists, think that the yardstick, the touchstone, the criterion of success in treating patients is keeping them away from the surgeon," he added.

If medicines are doing the job, that's great, Sachar said. "But often the swiftest, safest, surest treatment for ulcerative colitis is an operation. The name of the game is not saving colons, but saving lives, and that includes quality of life," he said.

Patients and doctors must decide on a case-by-case basis, he said.

SOURCES: Meenakshi Bewtra, M.D., M.P.H., Ph.D., gastroenterologist and assistant professor of medicine and epidemiology, University of Pennsylvania Perelman School of Medicine; David B. Sachar, M.D., gastroenterologist and clinical professor, medicine, Icahn School of Medicine at Mount Sinai, New York City; July 13, 2015, Annals of Internal Medicine

HealthDay