Fewer Cuts to the Gut

Inflammatory bowel disease patients have had surgery risk fall over the past six decades

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) New medications have improved the quality of life for patients with inflammatory bowel disease. But when these treatments fail to relieve symptoms, bowel surgery may be required.

According to a recent study, the risk of having to undergo surgery has fallen significantly in the past six decades.

Though the study did not determine the cause of this lower risk, the authors suggested that the reduction may be due to earlier detection, better care and treatment.

"Ask your doctor about new treatments for inflammatory bowel disease."

This study was conducted by Alexandra D. Frolkis, PhD, of the University of Calgary in Canada, along with colleagues.

The aim of this study was to look at the risk of having to undergo surgery among patients with inflammatory bowel disease and whether this risk has changed over time.

Inflammatory bowel disease is a condition in which the immune system attacks the body’s own cells and causes swelling and sores in the lining of the gut. Patients have symptoms including abdominal pain, diarrhea and blood in the stools. The two main types of inflammatory bowel disease are ulcerative colitis and Crohn’s disease.

Usually, the symptoms of inflammatory bowel disease subside with medications such as steroids, azathioprine (brand name Imuran) and infliximab (brand name Remicade). Surgery is performed when symptoms persist even after treatment.

The researchers looked at 30 studies that included data from the general population. These studies examined risk of surgery at one, five or 10 years after a diagnosis of inflammatory bowel disease.

In the case of Crohn’s disease diagnosed after 1990, the researchers found that the risks for surgery at one, five and 10 years after diagnosis were 14.3 percent, 27.7 percent and 38.7 percent, respectively.

For ulcerative colitis diagnosed after 1990, the risks for surgery at one , five and 10 years following diagnosis were 4.1 percent, 9.9 percent and 13.7 percent, respectively.

The researchers found that the risk for surgery for both of these conditions decreased significantly over the previous decades. They also used statistical methods to show that this reduction in risk was not a chance occurrence.

The authors pointed out some limitations of their study. First, this study was conducted by looking at previous studies, so the patient population varied across studies. Also, the study did not determine why the risk for surgery for inflammatory bowel disease had fallen.

"The reduction in surgery may be attributed to changes in practice patterns over time including earlier disease detection, introduction of practice guidelines, promotion of continuing medical education for IBD, shift in care from surgeons to gastroenterologists, reduction in colectomies for dysplasia or colorectal cancer, and advocacy of patients through Crohn's and Colitis Foundation chapters," the study authors wrote.

According to Maxwell Chait, MD, FACP, a gastroenterologist at the Columbia Doctors Medical Group and assistant clinical professor of medicine at Columbia University, “Medical therapy is central to the management of inflammatory bowel disease (IBD), which includes ulcerative colitis and Crohn’s disease. However, surgical management is an important component of therapy since it alleviates symptoms, addresses serious complications, improves quality of life, and, in some settings, is life-saving.

“Advances in medical therapy, including the use of infliximab, may have reduced catastrophic complications such as massive hemorrhage, perforation, severe colitis, and acute colonic obstruction as well as the need for surgery,” Dr. Chait explained.

The results of this study were published in July in Gastroenterology, the official journal of the American Gastroenterological Association.

The research was funded by a grant from Alberta Innovates-Health Solutions. A few of the study authors disclosed consulting relationships with several pharmaceutical companies including Jansen, Merck and Abbott.

Review Date: 
August 13, 2013
Last Updated:
August 15, 2013