Patients over 50 with ulcerative colitis (UC), 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 the University of Pennsylvania. The results are published this week in Annals of Internal Medicine.

“Ulcerative colitis is a chronic disease that most physicians opt to treat with medications, as opposed to surgery,” said the study’s lead author Meenakshi Bewtra, MD, PhD, MPH, assistant professor of Medicine and Epidemiology at Penn. “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.

The convention in treatment of UC is that surgery is considered 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. These medications effectively control the disease in less than 50 percent of patients.

In a retrospective study, Bewtra and colleagues analyzed data from the Centers for Medicare and Medicaid Services (CMS) 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. The researchers defined advanced UC as those patients who had had at least one hospitalization for UC, had two or more corticosteroid prescriptions within a 90-day period, or had any prescription for immunosuppressant therapy.

The study identified 32,833 UC patients 18 years of age and older who had at least six months of Medicare/Medicaid eligibility and who fit the inclusion criteria. Of these, 830 underwent elective colectomy and the remaining 32,003 were managed on drug therapies.  

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