New evidence suggests that patients who undergo surgery for ulcerative colitis (UC) may live longer than those who are treated with medication only. These findings were published in the Annals of Internal Medicine. 

Ulcerative colitis is a type of inflammatory bowel disease (IBD), a condition where you have chronic inflammation in your gastrointestinal tract caused by an autoimmune response. The lining of the colon becomes inflamed and develops tiny open sores, or ulcers, that produce pus and mucous. The combination of inflammation and ulceration can cause abdominal discomfort and frequent emptying of the colon.

There are two types of IBD, UC and Crohn’s disease. Ulcerative colitis is limited to the colon (the large intestine), whereas Crohn’s disease may affect any part of your gastrointestinal system.

People with UC often need lifelong treatment, which may consist of medicine, surgery, and lifestyle changes. Most of the medications used to treat UC work by reducing inflammation and the body’s immune response. Options for surgery for UC include removing the colon and rectum (proctocolectomy with ileostomy) and a procedure in which the colon and rectum are removed, but the patient can continue to pass stool through the anus (restorative proctocolectomy).

Patients with UC often have to choose whether they’ll be treated with long-term medication or have surgery to remove their colon. So far, research hasn’t proven if one approach improves survival time over the other. Recently, however, a study sought to determine whether patients with UC who underwent elective removal of their colons lived longer than those who were treated with medication.

Researchers looked at records from all 50 states from patients who had been treated for UC. The patient information had been recorded between 2000 and 2011. The records included 830 patients who had their colons surgically removed and 7,541 patients who had been treated with medication.

Patients who had elective surgery to remove their colons appeared to live longer—specifically, they had a 33 percent reduced risk of death compared to patients treated with medication. Patients whose survival improved the most with surgery were 50 and older and had advanced UC.   

Surgical removal of the colon is often considered a last resort for patients with UC—a therapy to turn to when medications aren’t effectively treating the condition or disease is advanced. According to these findings, however, patients who undergo surgery for UC electively, meaning before trying long-term medication, appear to live longer than those who use medication. It’s likely that some doctors will start to consider surgery as an earlier treatment option. 

Reference: Bewtra M, Newcomb CW, Wu Q, et al. Mortality Associated With Medical Therapy Versus Elective Colectomy in Ulcerative Colitis: A Cohort Study. Annals of Internal Medicine [early online publication]. July 14, 2015.

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