After resection, what factors are taken into account by a physician when deciding whether to utilize medication to maintain remission.

[David]

A member recently asked our panel of experts:

After resection, what factors are taken into account by a physician when deciding whether to utilize medication to maintain remission. Or should maintenance medicines always be used?

Dr. Walter A. Koltun, MD, FACS, FASCRS of the Penn State Hershey Inflammatory Bowel Disease Center took time out of his busy schedule to answer this question. A little about Dr. Koltun:

Dr. Koltun is the Director of the Hershey Penn State IBD Center, Chief of the Division of Colon and Rectal Surgery, and Professor of Surgery at the Penn State College of Medicine

In regards to the question, Dr. Koltun stated:

Many factors are considered after surgery. Typically if the patient is at high risk of recurrence, and if such recurrence would be very risky, then medications, possibly very strong medications are started soon after surgery. Risk factors for early and health threatening recurrence of disease(in Crohn's disease) includes more than the average amount of intestine being removed previously, very rapid progression from diagnosis to surgery, numerous previous surgeries and if the bowel was put back together(as opposed to getting a stoma).

The most common operation for crohn’s disease is an ileocolectomy where typically a short segment of the bowel is removed and then the bowel put back together. However, if more than a little has been removed, or the patient has had multiple previous resections, then medications are usually started right away. If this is the first surgery and the patient was diagnosed 10 years before coming to surgery, for example, then the disease appears to be indolent and medications may not be started and instead a colonoscopy done at 6 -12 months to see if the disease is coming back. If it is, then medications are added. Interestingly, patients who get a stoma (an external bag) have a lower incidence of recurrence and frequently will never need medications again, although this is not certain, but clearly a stoma bag decreases the chance of the disease coming back.

Thank you to Dr. Koltun for his time and expertise!

 

[grt73]

That's very interesting, thank you for the advice as I am currently sporting an ileostomy and am hoping at some point to have it reversed. With any luck it will leave me alone in future! Here's hoping