The position of surgery in the treatment of ulcerative colitis (UC) has changed in the era of biologics. Several important questions arise in determining the optimal positioning of surgery in the treatment of UC, which has long been a challenge facing gastroenterologists and surgeons. Surgery is life-saving in some patients and leads to better bowel function and better quality of life in most patients. The benefits of surgery, however, must be weighed against the potential surgical morbidity and compromised functioning that clearly can occur. The introduction of biologic therapy has added further complexity to decisions about medical management, surgery, and the relative timing of these choices. Appropriate medical management of UC may induce and maintain remission and may prevent surgery. However, medical management also carries risks of adverse effects, and recent data suggest that delay of surgery during ineffective medical therapy can increase the chances of negative surgical outcomes. To make individualized timely treatment decisions, early collaboration between gastroenterologists and surgeons is important and more data on predictors of treatment response and positive outcomes are needed. Early identification of patients who would benefit from biologic therapy or surgery is challenging.
Article first published online 10 July 2013
*Department of Surgery, University College Hospital, London, United Kingdom;
†Gastro-entérologie La Source-Beaulieu and Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland;
‡Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands; and
§Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
Reprints: Subrata Ghosh, MD, Foothills Medical Centre, University of Calgary, 9th Floor North Tower, 1403-29th Street NW, Calgary, Canada (e-mail: Subrata.Ghosh@albertahealthservices.ca).
A. Windsor received payment for lectures including services on speakers bureaus from Warner Chilcott and Ferring, and payment for manuscript preparation and development of educational presentations from Lifecell. P. Michetti received payment for consultancy for MSD, UCB and Abbott; grants from MSD; payment for lectures including service on speakers bureaus from MSD, UCB and Abbott; and payment for development of educational presentations from MSD. W. Bemelman received payment for consultancy for Johnson & Johnson and AbbVie; grants from Johnson & Johnson and Achmea; payment for lectures including service on speakers bureaus from Johnson & Johnson, Lifecell, Abbott, and MSD; and travel/accommodations/meeting expenses unrelated to activities listed from Johnson & Johnson, Lifecell, and Abbott. S. Ghosh received payment for consultancy for Janssen and Abbott; grants from Abbott; payment for lectures including services on speakers bureaus from Janssen and Abbott; and payment for development of educational presentations from Abbott.
The authors have no other conflicts of interest to disclose.
Supported by Merck Sharp & Dohme Corporation, Whitehouse Station, NJ. Medical writing assistance was provided by Ellen Stoltzfus, PhD, of JK Associates, Inc., Conshohocken, PA, and Jacqueline M. Mahon, MA, of Synergy Medical Education, Conshohocken, PA. This assistance was funded by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Whitehouse Station, NJ.
Received February 20, 2013
Accepted March 19, 2013