When to consider surgery for IBD
There are several medical treatments currently available for the management of IBD. Some of those treatments include the use of one or more of the following: antibiotics, anti-inflammatory agents, steroids, biologic therapies and monoclonal antibodies. When these treatments do not provide improvement or the side effects out weight the benefits of use patients may turn to surgical options.
It can still be very difficult for a patient to determine exactly when they should consider a surgical option. It can become even more difficult when weighing whether surgery will be curative or just a temporary fix. According to the Department of Health & Human Services some patients and doctors may feel that surgery is a failure at treating IBD (1). This is simply not the case! Some patients respond very well to treatments and others do not. It is not a “failure” of the patient or the physician to explore surgical options.
The Crohn’s and Colitis Foundation of America’s website states that as many as 20% of people with ulcerative colitis (UC) will require surgery in their lifetime. Although surgery is not thought to be curative in the treatment of Crohn’s disease it is estimated that 66-75% of people with the disease will have one or more surgeries to manage symptoms (2).
There have been some guidelines developed to better determine when surgery is indicated in IBD. For Crohn’s disease surgery may be warranted when there is uncontrollable bleeding, bowel obstruction, bowel perforation, the presence of an abscess, fistula, stricture or perianal disease. It can also be indicated when a patient fails to respond to medical treatments (3). In UC surgery may be needed if there is uncontrollable bleeding, bowel perforation, bowel obstruction, toxic mega colon, cancer and may also be needed when a patient has been unresponsive to medical treatment (3).
With UC the total removal of the colon and rectum, called a total proctocolectomy, is thought to be a permanent cure for the disease. In Crohn’s surgical treatment is used when symptoms can no longer be controlled with medications. The surgery that is typically seen in Crohn’s is a bowel resection (2).
As with any surgery it is important to go over the risks versus the benefits of surgical treatments. This can help a patient who may believe they fall into a “grey area” decide whether it is time to have surgery or not. It may also help to quantify the affect your IBD has had on quality of life. Tools like the IBD journal and flare assessment quiz on this site can help you and your doctor assess whether treatments are working and how frequently you are in pain.
Tune in next month as I discuss IBD surgery in more detail.