Physicians given new treatment option for ulcerative colitis

Imagine being 20 years old and not being able to sit through a movie date without running to the bathroom three or four times, or needing a shopping partner to ensure your place in the check-out line. Think about not being able to attend your child’s baseball game because the bathroom is not easily accessible.

As a gastroenterologist, I see hundreds of patients like this every year suffering from the debilitating effects of ulcerative colitis (UC), a chronic and painful inflammatory bowel disease (IBD).

Canada has one of the highest incidences of IBD in the world, estimated at nearly 170,000 Canadians with approximately 10,000 new cases diagnosed each year. IBD is an umbrella term that covers both UC and Crohn’s disease (CD).

Most people with UC are diagnosed when they are quite young, between the ages of 15 and 35, and both men and women are affected equally.

The effects of ulcerative colitis can be devastating and can severely impact a patient’s quality of life. Patients suffer from diarrhea, severe abdominal pain and cramping, rectal bleeding and fatigue. During a disease flare-up, it is not uncommon for patients to go to the bathroom up to 20 times a day, or more.

If not properly treated, symptoms may worsen, causing complications such as profuse bleeding from ulceration and perforation of the bowel.

Until recently, patients with UC had very limited options for treating their condition.

With Health Canada’s approval, Canadian physicians, for the first time, are now able to prescribe Remicade¨ (infliximab) to treat Canadians with moderate to severe UC. The approval makes Remicade the first and only biologic therapy approved to treat UC in Canada. The therapy has been used in Canada since 2001 to treat CD, the other form of IBD.

For patients who have failed conventional therapies, Remicade has been shown to be an effective treatment which can enhance quality of life while reducing the need for surgeries and hospitalization.

Prior to the approval of this medication, surgery was often the only option for those patients who had failed conventional therapies. However, the surgical solution, a colectomy, involves the removal of the large intestine and carries some significant risks for patients, such as infertility and incontinence.

Following surgery, the ability of women to become pregnant can be reduced by as much as 80 per cent. Surgery also carries the risk of nighttime fecal incontinence in approximately 24 per cent of patients, which, understandably, can be traumatic for a young person. It is also important to note that in approximately 50 per cent of patients the pouch formed during surgery to create a new rectum may become inflamed (“pouchitis”), causing pain, bleeding and diarrhea, all symptoms of UC which the patient had been seeking to avoid through surgery in the first place.

Now, with the approval of Remicade, physicians are able to offer patients a viable alternative to surgery. In my own practice, I have seen this medication allow patients, who had previously been chronically ill and living with significant disability, lead active and relatively symptom-free lives. With Health Canada’s approval, more patients will benefit from this treatment, and physicians across Canada will have a new addition to their armamentarium for treating UC – one that can provide patients with a medical alternative to invasive surgery.