Consider: Up to 30 percent of people with severe UC who are hospitalized for the condition will undergo a colectomy, the surgical removal of the colon, within one year of being hospitalized for UC for the first time, according to the Crohn’s & Colitis Foundation. “The colectomy rate hasn’t budged in over 30 years,” says Fernando Velayos, MD, the regional director of the inflammatory bowel disease program for Kaiser Permanente Northern California and a clinical professor of medicine at the University of California, San Francisco. But a new study published in January 2020 in Inflammatory Bowel Diseases tracked the colectomy rate in the Kaiser Permanente Northern California health system of people with UC who underwent surgical colon removal from 2009 to 2017, and researchers detected signals that the surgery rate for UC is trending downward. In the study, people with UC were tracked for up to one year after being hospitalized with severe UC for the first time. During that first hospital visit, 5.3 percent of them had their colon removed, compared with the historical rate of 20 percent. For people who avoided colon removal at that first hospitalization, 11.9 percent went on to have their colon removed within a year, which is a significant improvement. In the past, about 30 percent of people with UC had their colon removed within the first year of being hospitalized for the condition for the first time. “The risk for surgery for UC seems to be much less than in the past,” says Dr. Velayos, the lead author of the study. “That’s good news for patients.”
Care Pathways Pave the Way for Improvement
Velayos suspects that the lower surgery rate is due to the introduction of care pathways, specific UC treatment protocols recommended by the American Gastroenterological Association that were designed in 2001 to help doctors prescribe the best treatment for people with UC. Care pathways include the use of biologics and other medication. Because of care pathways, more people hospitalized with UC are now prescribed a corticosteroid like Sterapred (prednisone) and biologic medication early on. “If people are sick enough to be in the hospital because their colitis has flared severely, they get a dose of prednisone, and then we reassess after about three days,” Velayos says. If their UC doesn’t improve within three days, they have the option of trying a biologic medication, such as Remicade (infliximab), which is the medication many of the 524 patients received in Velayos’s study. With UC, the immune system can produce too much TNF-alpha, a protein that can cause inflammation in the digestive tract, leading to UC symptoms. Remicade can induce UC remission by blocking TNF-alpha. As care pathways indicate, patients should receive a dose of the drug in the hospital, then again two and six weeks later, then every eight weeks after that. Remicade is just one of four biologic medications approved for UC by the Food and Drug Administration; all target TNF-alpha. “If people with UC respond to a biologic like infliximab, they’re on the medication long term,” Velayos says. RELATED: 9 Common Digestive Conditions From Top to Bottom
Temporary Reprieve or Permanent Solution?
Before biologic medications became the standard of care, complete colon removal was likely the only option for survival for people with severe UC that didn’t respond to Sterapred. “Before, surgery seemed to be immovable. Our study tells us that there is a role for optimism, that the risk of surgery seems to be much less than in the past,” Velayos says. “The next step is trying to understand what caused the reduction in hospitalizations.” The study begs the question: Are care pathways and biologic medications merely buying people with severe UC more time until they inevitably must succumb to the knife? “We have to look further, but it looks like these general improvements in medical care are actually helping a good percentage of patients with UC avoid surgery altogether,” Velayos says.
