There are a few topics that are known to get the inflammatory bowel disease (IBD) community fired up. For example: Whether a patient can have both Crohn’s disease and ulcerative colitis (UC), the proper spelling of Crohn’s, and one of my all-time favorites: Is a colectomy a cure for UC?
Hold onto your butts, everyone; this is going to be a doozy.
Defining cure, colectomy, and ulcerative colitis
To really understand whether or not a colectomy is a cure for UC, it’s important to be clear on what a cure is, what a colectomy is, and what UC is.
Cure: According to Merriam Webster's medical dictionary, a cure can be defined as “recovery from a disease” or
“remission of signs or symptoms of a disease especially during a prolonged period of observation.”
Colectomy: A colectomy is defined as “excision of a portion or all of the colon.”
Ulcerative colitis: The Mayo Clinic defines UC as “an inflammatory bowel disease (IBD) that causes long-lasting inflammation and ulcers (sores) in your digestive tract. Ulcerative colitis affects the innermost lining of your large intestine (colon) and rectum.”
But what does it really mean to ‘cure’ ulcerative colitis?
If you were to ask me if I think a colectomy is a cure, I’d ask you which definition of “cure” you’re using. In the definition above, you can see a cure is described as “recovery from a disease” and “remission of signs and symptoms of a disease.” I would definitely say that there was relief from UC in my colectomy, but I would never say that it was a total “recovery” because it didn’t solve or eliminate all of my IBD-related problems.
Many medical professionals will often tout a colectomy as a cure, and I think if we use a “relief” version of the definition, they’re right. However, the world uses the term “cure” so flippantly that it’s meaning changes depending on the context. If we’re talking about curing a hangover, I’m looking for a lot less in terms of long-term outcomes than if we’re talking about curing UC.
When talking about a cure in context of a medical condition, I think most patients are looking for a cure that will permanently eliminate the problem and leave them without any residual complications or conditions.
Is a cure all-encompassing?
If we look at the “recovery” version of the cure definition, and take into account that UC causes inflammation and ulcers in the large intestine and rectum, can we say that a colectomy solves this issue?
Yes and no.
A colectomy will remove some or all of the large intestine and all but approximately 3 centimeters of the rectum, but any large intestine that is left behind and even those 3 tiny centimeters of rectum can still flare in a UC patient.
A flare in this form is not as debilitating as it was before the colectomy, but it’s still uncomfortable, causes urgency, and most often needs to be treated by medication. If UC can still flare, and still cause discomfort, I would argue that a colectomy does not lead to “recovery” from UC.
Part of what makes this argument so complicated is the idea of the “cure as a cause” for other problems. If a patient has a colectomy, and then they live with a J-pouch, but the J-pouch is constantly inflamed with pouchitis, leaving the patient just as miserable as before the colectomy... then is the colectomy still a cure? If the cure causes other ailments, does it still count? Does each medical woe need its own specific cure in order to use this word to describe the elimination of symptoms?
In my personal definition of a cure, I believe that if the cure causes other conditions that you wouldn’t have had prior to the treatment, then that’s not truly a cure.
Look at the J-pouch example from above: A patient would have never gotten pouchitis prior to a colectomy. It’s impossible. So receiving a J-pouch due to their colectomy and later experiencing pouchitis would make the colectomy partially responsible for the pouchitis — therefore, I feel it’s not a cure.
Is your brain spinning yet?
Defining a UC cure: Fact or opinion?
The root of this whole argument is in the nuances of the word “cure.” What does it mean to you?
I could argue this topic in circles if my opponent and I have different definitions of a cure. I have argued this very topic with doctors, colorectal surgeons, and heads of very important IBD-related nonprofits because what is not taken into consideration is what a patient deems a cure.
If I could go back in time, I’d ask my surgeon what his definition of a cure was so I could better understand what he was promising when he said my colectomy would be a cure. When he said this, I assumed we were on the same page, which was, “You won’t have UC, you won’t experience any of the pain you currently have, and you won’t continue to have issues with digestion.” We were definitely not on the same page.
I, personally, believe that a colectomy does not eliminate all problems or solve them, which means it's not a cure. I do strongly believe that a colectomy will greatly reduce most symptoms in the majority of patients, improving their quality of life. I always say you’re trading one big set of problems for a smaller, more manageable set of problems, but you aren't eliminating the problems all together.
The difference between relief and total elimination of UC symptoms can be drastic. Relief can come in the form of an oral steroid, an antacid, or even something as simple as an aspirin. Permanent elimination of symptoms is much harder to achieve, and I’m not convinced it’s even possible yet.
It’s crucial to note the differences in these two definitions and to remember that they are both commonly used when talking about a “cure.” Having a discussion to define a cure with yourself, your medical team, and your family means you’ll be setting realistic expectations of your care and recovery from surgery.