Hundreds of young patients aged between 15 and 30 with inflammatory bowel disease may be having unnecessary major surgery because of failure to use new ‘rescue therapies’, a leading specialist claimed yesterday. (Tuesday)
A UK-wide audit of hospitals revealed that less than a third of patients with ulcerative colitis who could benefit from rescue therapy had received it, said Dr. Simon Travis, of The John Radcliffe Hospital, Oxford.
Surgery can involve three different operations which involves removing the colon and reshaping the remaining bowel into a pouch. Waste is passed through an external bag attached to the abdomen between the first and final operations.
Traditionally, patients had surgery if steroid drugs did not control their symptoms, but ‘rescue therapy’ was highly effective if steroid drugs failed – so long as the decision to start it was taken within three or four days, said Dr. Travis.
Speaking at the meeting of the Association of Coloproctology meeting in Glasgow, he said that about 3000 patients a year were admitted to hospital each year with severe colitis.
He added: “Of these about 30 per cent undergo surgery, but we now know that about a third of these operations could be avoided.”
‘Rescue therapy’ includes ciclosporin, also used to combat transplant rejection, and infliximab, one of a new class of drugs known as monoclonal antibodies. It can help about a third of patients who would otherwise have to undergo the trauma of surgery.
Dr. Travis said that many gastroenterologists were anxious about the potentially hazardous side effects of ‘rescue therapy’, but he added: “Used too late it can be dangerous, but used early, within three days, it can be highly effective.”
“One reason that the decision to administer these treatments early is not taken more widely is that when patients are given intravenous fluids and steroids when they first come to hospital, they always feel better the following day.
“But this can create a misleading picture – the patient may not be making a significant recovery. All this can result in a delay in giving rescue therapy and it is this which can lead to potentially dangerous complications.”
Dr. Travis and other speakers also emphasized the critical need to operate promptly on patients who did not respond to drugs. Surgeon Paul Finan, President of the Association of Coloproctology, stressed the need for surgeons and physicians to work together because delaying surgery was also potentially dangerous if the patient’s condition was deteriorating.
Ulcerative colitis results in inflammation of the large bowel and causes ulceration and bleeding from the lining of the colon. It can cause diarrhoea, severe abdominal cramps, fever, lethargy and weight loss, though sufferers may experience prolonged periods without any symptoms.
Press Contact: Evelyn Vittery, Bloomsbury Communications 0207833 3759 or evelyn@bloomsburycommunications.com
Added on: 11th September 2007
This page was last updated on 11-09-2007