For the more than half a million Americans living with a form of inflammatory bowel disease known as ulcerative colitis, daily life can include more than 20 trips to the bathroom, painful cramping, and bloody diarrhea.
Physicians typically prescribe powerful immunosuppressants or corticosteroids to combat those symptoms, and turn to surgical removal of the colon only after everything else has failed.
But new findings suggest operations should be considered more often.
In a study published this month in the journal Annals of Internal Medicine, researchers at the University of Pennsylvania identified a potential perk of surgery: a survival advantage. The team analyzed Medicare and Medicaid records and found that the five-year death rate was 30 percent lower in ulcerative colitis patients who opted for an operation compared with those who stuck with medications.
The effect was strongest in patients over 50.
“We often think of surgery as being more “dangerous” in patients who are older,” said Meenakshi Bewtra, an assistant professor of medicine and epidemiology at Penn, and lead author of the work. “But this study shows that surgery is quite the opposite.”
Mount Sinai gastroenterologist David Sachar, who was not involved in the research but wrote an accompanying editorial, cautioned that the result should not be overinterpreted. Although the study tried to match patients for severity of disease and other factors, it was not a randomized controlled trial, medicine’s gold standard.
“I don’t think anybody is going to rely on this study to recommend to a patient, you should have an operation because you’ll live longer,” he said.
But, he added, he hoped it reminds doctors that surgery isn’t a treatment failure.
“There are a substantial number of cases where surgery is the better treatment,” he said. “It shouldn’t be feared just because, from the patient’s point of view, it’s an operation and kind of scary. Or, especially from the doctor’s point of view, because the doctor’s ego is somehow wrapped up in the situation, and the doctor thinks that his or her goal is to spare the patient from surgery.”
Since ulcerative colitis affects only the colon, removal of the organ eliminates disease, although going without it presents its own challenges, such as a colostomy bag.
“Every patient I have uniformly says, ‘Oh my goodness, no, I could never live with that,'” said Bewtra.
But afterward, she said, those patients often wonder why they didn’t do it sooner.