There has been some interesting Inflammatory Bowel Disease news in the media the past month or two and I thought I would pass along some of the highlights.
IBD & Pregnancy
For women with IBD who are also of child-bearing years you may be interested in some information that was published in the October issue of Gastroenterology. Dr. Uma Mahadevan-Velayos from the University of California, San Francisco, told Reuters Health that, "Women with IBD, even with inactive disease and low-risk medication, are at increased risk for adverse pregnancy complications compared to women without IBD. These women should be followed as high-risk OB patients."
In the study, Dr. Mahadevan-Velayos evaluated the pregnancy outcomes of 461 women with IBD and 493 women without IBD and assessed the potential risk factors for an adverse outcome. The researchers found that live births were less common among women with IBD (60%) than among women without IBD (68%). Cesarean section was more common among women with IBD (13%) than among those without IBD (9.5%). The report also indicates that women with IBD were also more likely than women without IBD to have an adverse conception outcome, an adverse pregnancy outcome, or a complication of pregnancy. Dr. Mahadevan-Velayos says that the gastroenterologist, obstetrician, and pediatrician should work together to ensure the best care for the mother with IBD and her child.
Colonoscopy Anesthesia Excluded by Aetna
In the December 28, 2007 issue of The New York Times it was reported that Aetna, one of the nation's largest private health plan managers, will no longer cover the anesthetic drug, propofol, as of April 1, 2008. Propofol is often used to eliminate the discomfort of undergoing a colonoscopy and Aetna plans to classify the drug as "medically unnecessary" for most procedures. Critics of Aetna's decision say this is a step backwards in the battle against cancer of the colon and rectum.
I also find it a possible set-back for people living with IBD who receive routine colonoscopies to monitor their disease. As far as I can tell the main reason that Aetna has decided to stop covering the use of this drug in colonoscopy procedures is because administering propofol can be tricky. According to The New York Times, the drug acts rapidly and there is no rescue drug available to counteract its effects if the patient begins to have trouble breathing. Because of this risk most gastroenterologists want an anesthesiologist to assist them when using the drug, which can increase the costs of a colonoscopy by $300 to $1,000.
Many specialists claim scant evidence that propofol helps enough to make the cost worthwhile. And all three major medical associations for specialists who perform colonoscopies have published guidance statements saying the anesthetic was not needed for routine procedures.
So, before having your next colonoscopy discuss with your doctor what anesthetic will be used and then check with your insurer to confirm that it is covered by your plan.