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Patients over 50 with ulcerative colitis, a chronic disease of the colon, who undergo surgery to treat their condition live longer than those who are treated with medications, according to a new study from the Perelman School of Medicine at University of Pennsylvania. The paper by lead author Meenakshi Bewtra, a UPenn assistant professor of Medicine and Epidemiology, were published in the Annals of Internal Medicine.
“Ulcerative colitis is a chronic disease that most physicians opt to treat with medications, as opposed to surgery,” Bewtra is quoted saying in a July 14 press release from the university. “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, or the large intestine. The inflammation can cause abdominal discomfort, bleeding, and diarrhea. It affects as many as 700,000 Americans, according to the Crohn’s & Colitis Foundation of America. Men and women are equally affected, with most patients diagnosed by their mid-30s. Physicians conventionally consider surgery a treatment of last resort. However, medical treatments, involving immunosuppressant and steroid drugs, come with significant side effects, and can increase the risk of infection and some cancers, Bewtra et all note. These medications effectively control the disease in less than 50 percent of patients, they say.
Bewtra and colleagues analyzed data from the Centers for Medicare and Medicaid Services 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. Data on 32,833 patients was examined.
Mortality rates associated with elective colectomy and medical therapy were 34 and 54 per 1,000 person-years, respectively, thus showing that elective colectomy was associated with an improved survival rate. The findings also suggested a benefit for surgery in those patients who could not sustain a disease remission – defined as stable disease without the need for hospitalization or changes to drug therapy — on immunosuppressant therapy, but further work is needed to confirm these results.
“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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