Choice of a Pill or Surgery for Ulcerative Colitis

Ulcerative colitis treatment options may vary in terms of patient preference

(RxWiki News) Some conditions can only be treated with medication or surgery. Others, such as ulcerative colitis, can be treated with both options.

Ulcerative colitis is an inflammatory disease involving the large intestine. Both surgery and medication for this condition involve long-term risks.

A recent study found that patients with this condition would choose medication treatment over one particular surgery option when informed of the risks and benefits of both.

Another surgery, however, seemed more acceptable to the participants if medication was not going to work completely.

"Discuss ulcerative colitis treatment options with your gastroenterologist."

This study, led by Meenakshi Bewtra, MD, MPH, of the Department of Gastroenterology at the University of Pennsylvania, investigated whether patients prefer medication or surgery to treat their ulcerative colitis.

The medications used to treat this condition are called immunosuppressive because they prevent the immune system from overreacting. However, being on immunosuppressive therapy long term can increase the risk of infection and cancer since the immune system is not operating at its full potential.

Surgery for ulcerative colitis, on the other hand, causes a permanent change in how a person's bowels function.

Dr. Bewtra and team developed an experiment that would measure how 293 patients with ulcerative colitis would decide which treatment they preferred.

The researchers determined that patients were more concerned about avoiding surgery than about the risks of infection or cancer based on the information provided.

The information about the surgery discussed the surgery type available and the side effects of it.

The information about infection and cancer included discussion of the risks of death over a 10-year period.

Also included in the decision-making model was information about the severity of their disease and the likelihood of remission.

Participants were willing to accept having a more than 5 percent risk of dying over 10 years from cancer or infection if it meant they could avoid getting a surgery called an ostomy.

An ostomy involves creating an hole leading from the bowel to the outside of the body.

The participants preferred the cancer or infection death risk over the surgery regardless of how effective the medication was and regardless of their disease severity and likelihood of remission.

However, when presented with the possibility that medication treatment might not be effective enough to lead to remission, the patients found that option just as acceptable as a different type of surgery called "J-pouch."

A J-pouch surgery involves using a portion of the small intestine to act as a holding place for feces after the large intestine — which includes the colon — has been removed.

Other factors influencing the participants' decision-making were their individual characteristics and their personal health history with ulcerative colitis.

"Patients with ulcerative colitis are willing to accept relatively high risks of fatal complications from medical therapy to avoid a permanent ostomy and to achieve durable clinical remission," the researchers concluded.

This study was published in the January issue of the journal Inflammatory Bowel Diseases. Information regarding funding and disclosures was not available.

Review Date: 
February 20, 2014