Colectomy as an option

I have had UC for 30 years. I have had few flareups and my last colonoscopy a year ago revealed mild dysplasia. I had a very severe flareup from Feb. 2007 until June of 2007 during which time I was taking a decreasing dose of prednisone starting at 1mg/kg bid which I finished with around June 14. I was also taking mesalamine 1.2g tid.  I had typical side effects from prednisone and have been loosing my hair probably due to the mesalamine. My GP recently ran a panel and discovered me to be pre-diabetic [fasting BG of 103].  I have had no other diagnostics run around the pre-diabetes so I am not sure if it is due to life style/diet or is related to the long-term prednisone causing insulin resistance and resulting inbility of the pancreas to produce insulin.  My gastroenterologist wants me to start azothioprine. I am concerned about the potential for blood dyscrasias and the association w/ pancreatitis. So - neither one of the drugs which would put me into remission feel like viable choices. What is your opinion about a pre-emptive colectomy?  I am concerned that if I want until the next flareup the tissue will be so unhealthy that surgery might not be an option.  Just looking for an alternative opinion. Thanks.

[Ratnakar Kini, MD]

Hi,
In individuals with UC, surgery is indicated if any of the following is present-
Uncontrolled bleeding, toxic megacolon, perforation, UC not controlled by medications, unwanted side effects of medications, dysplasia, cancer.
Since you have some of these, you may consider surgery as an option.
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The information provided is for patients’ education only and is not a medical advice. Always consult your personal physician for complete evaluation of your health problem.

- Ratnakar Kini M.D.