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• W1570232868 abstract "Sirs, Being a surgeon, I am impressed and amazed by the enthusiasm and energy that gastroenterologists display when performing pharmacological trials in inflammatory bowel disease. The randomized studies usually show that, in less than 30% of the patients, the disease pattern is modified compared with the natural course of the disease, provided one considers placebo as reflecting the unmodified disease pattern. These studies usually span some weeks, and rarely up to a year. Most of the studies are paid for by the pharmacological industry and therefore one can understand that there is a lack of patience waiting for long-term outcomes – although we are treating lifelong illnesses. Not only is the concern for the nonresponders rather low, but also we have very little information also on the long-term benefits in those who have responded. The study by Herrlinger et al. describing rescue therapy with infliximab after tacrolimus in acute colitis is another of these studies.1 It was performed with good intent and independently from the industry. The aim might be justified, but I cannot agree with the general conclusion that up to one-quarter of the patients may benefit. The studied group of patients was seriously ill because of colitis, with the prospect of high morbidity and even a risk of mortality. In this situation, the concern should be with those who did not respond and were operated late in the disease course. Delayed surgery is seen more often today and, although there is no hard evidence, it is likely that it incurs a higher surgical risk. Mortality can be avoided in the vast majority of cases thanks to modern anaesthesiology and intensive care. The better conclusion from this study1 would be that rescue therapy with infliximab after tacrolimus should not be recommended – especially so as one can presume that the majority of those few who seemed to benefit will enjoy indefinite remission. Surgery for UC, although giving most patients an excellent quality of life, is not the perfect solution for these patients. No doubt, pharmacological therapies will improve with time and may well abolish the need for surgery, but we are not there yet. Declaration of personal and funding interests: None." @default.
• W1570232868 created "2016-06-24" @default.
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• W1570232868 date "2010-04-02" @default.
• W1570232868 modified "2023-10-18" @default.
• W1570232868 title "Ulcerative colitis: failed tacrolimus - infliximab or surgery?" @default.
• W1570232868 cites W2068530552 @default.
• W1570232868 doi "https://doi.org/10.1111/j.1365-2036.2010.04343.x" @default.
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