BMJ  2007;335:1006 (17 November), doi:10.1136/bmj.39358.624005.BE (published 30 October 2007)

Editorials

Timing of surgery for inflammatory bowel disease

Thresholds for elective surgery may be too high

The first 150 words of the full text of this article appear below.

In this week's BMJ, Roberts and colleagues used record linkage analysis to compare mortality rates after elective colectomy, emergency colectomy, and no colectomy in people admitted with inflammatory bowel disease.¹ The results are important and indicate that thresholds for undertaking elective colectomy in clinical practice are too high.

The chronic inflammatory bowel diseases—ulcerative colitis and Crohn's disease—affect 1.4 million people in the United States and 2.2 million people in Europe.² They result in substantial morbidity, lost days at work, and reduced quality of life. Despite a variety of advances in medical treatment, 20-30% of patients with ulcerative colitis need surgery at some time,³ while the lifetime risk of surgery for Crohn's disease is as high as 80%.⁴ In people with severe inflammatory bowel disease the long term effectiveness of drugs, such as immunomodulators, rarely exceeds 40%. Surgery can be regarded as a cure for ulcerative colitis, albeit an imperfect . . . [Full text of this article]

Department of Gastroenterology, Guy's and St Thomas's Foundation Trust, London SE1 7EH

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Relevant Article

Mortality in patients with and without colectomy admitted to hospital for ulcerative colitis and Crohn's disease: record linkage studies

Stephen E Roberts, John G Williams, David Yeates, and Michael J Goldacre
BMJ 2007 335: 1033. [Abstract] [Full Text] [PDF]