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Mortality Associated With Medical Therapy in Ulcerative Colitis

What is the problem and what is known about it so far? Patients with active ulcerative colitis (UC) often have to decide whether to take stronger immunosuppressive drugs (for example, steroids or azathioprine) or have surgery to remove their colon (large intestine). It is not clear whether patients who choose to have surgery live longer than those who are medicated. Why did the researchers do this particular study? To find out whether the survival of patients who choose to have surgery differs from the survival of those who take medicines for UC. Who was studied? 8371 patients older than 18 years who were covered by Medicaid and/or Medicare between 2000 and 2011 and had active UC. Patients were defined as having active disease if they were hospitalized for UC, received 2 or more prescriptions for steroids within 90 days, or were prescribed an immunosuppressive drug. How was the study done? The 830 patients who had elective surgery to remove their colon were matched to 7541 patients who took medicines for treatment of active UC. Patients in both groups were followed until they died or the study ended. What did the researchers find? Overall, patients who chose to have surgery to remove their colon had better survival than those who took medicine. Among patients younger than 50 years, the survival of those who had surgery did not differ from the survival of those who took medicine. In patients aged 50 years or older, however, patients in the elective surgery group lived longer than those in the medical treatment group. What were the limitations of the study? Although Medicare and Medicaid are the primary health insurance for 1 in 5 Americans, the results of this study may not apply to the general population with active UC. What are the implications of the study? In Medicaid and Medicare patients with active UC, elective surgery was associated with better survival than medical therapy.