Medical Treatment

Medical treatment is the first line of treatment for Ulcerative colitis and Crohn’s disease. Medications reduce the inflammation and control the symptoms of the disease. Medications have to be used lifelong. Patients with mild to moderate symptoms do very well with medications and surgery is rarely required. However, in patients with severe disease and in those patients in whom medications do not work, surgery is life saving. The various drugs used to treat IBD are:

Aminosalicylates: These are anti-inflammatory drugs useful in mild disease and in long term maintenance therapy. Common names are Pentasa, Mesacol, Balsalazide. They can be used as tablets, enemas or suppositories

Corticosteroids: These are stronger anti-inflammatory drugs used as tablets or injections in patients with moderate to severe symptoms. These drugs are quite effective in controlling the inflammation. With continuous use they can cause lot of side effects such as development of diabetes, hypertension, weak bones and cataracts. They also increase the risk of infections. Because of these side effects, these drugs are used for only a short time. Once inflammation has reduced, these drugs should be stopped.

Anti-metabolities: These include Azathioprine and Mercaptupurine. They prevent multiplication of inflammatory cells and are used for long term maintenance therapy. They have adverse effects on the bone marrow, liver and pancreas but these adverse effects occur in less than 2-3%

Biologicals: These drugs are the result of modern research. They target individuals chemical pathways that cause inflammation in IBD. These are given as injections once or twice in a month for a long time. They are expensive and have certain side effects such as increased risk of infections. Two common drugs are Infliximab and Humira which targets a chemical called TNF-alpha in the intestines.

Surgery for IBD

Patients with IBD sometimes require surgery. Surgery is done to remove the areas of the bowel where is inflammation. Surgery gives quick relief and improves quality of life. The common scenarios when surgery may benefit in IBD are:

• Patients with severe symptoms not responding to medical treatment
• Emergency situations when there is severe bleeding or perforation of a part of the bowels
• Patients taking medications for a long time and having significant side effects
• Narrowing in the intestine of colon that is causing blockage
• Development of fistulas in Crohn’s disease that do not respond to medications
• Development of infection in the intestines that does not respond to antibiotics.
• With long standing IBD patients have a risk of developing colon cancer. Surgery is done in cases where there is actual cancer of high suspicion of cancer.

In patients with Ulcerative colitis, the disease is limited to the colon and removal of the entire colon cures the patient for the rest of his life. However, in Crohn’s disease, only the affected segments of the bowel are removed. Since Crohn’s disease can affect any segment of the bowel, it can recur even after surgery and continuous medications are required to prevent recurrence.

Surgery for IBD cannot be done any surgeon. It requires specific training and advanced medical knowledge. Each case has to be reviewed by a team of medical and surgical experts. Our team of experts in gastroenterology and colorectal surgery in U.A.E have a vast experience in the management of patients with IBD.

“Expert surgeons at our center, provide world class surgery options to help relieve your IBD. Our surgeons perform the operation laparoscopically.”

This is a big advantage since only few holes are made in the abdomen and then using precision tools, the surgery is done by special instruments and camera assistance. Using minimally invasive technique like Laparoscopic Surgery, helps in reducing pain and speedy recovery of patients.

The various surgery options used by our surgeons to provide long term relief to patients of IBD are:

Total Colectomy with ileostomy: This involves removal of the entire colon and rectum. The end part of small intestine known as terminal ileum, is brought out vide a small hole in the abdominal wall (ileostomy) through which he stools collect in a bag. This type of surgery is done only for advanced cases of ulcerative colitis especially in an emergency setting. It is always better to have ileal pouch formed so that stools pass from the natural orifice.

Restorative Proctocolectomy: This also involves removal of the entire colon and rectum. But the major difference here is that the end part of the intestine (terminal ileum) is fashioned into a pouch that is then connected to the anus. This pouch acts like a new rectum. This is known as ileal pouch anal anastomosis (IPAA). This is always a preferred surgery compared to a permanent ileostomy described above. Patient can go to the toilet normally after this surgery.

“Our surgery experts in Dubai are one of the few in the middle east who can perform this surgery totally by laparoscopy without a large cut on the belly.”

Bowel resection: This involves cutting and removing the affected segment of the diseased bowel. It is done in patients with Crohn’s disease to remove the most damaged segments of the bowel.

Fistula surgery: Patients with Crohn’s disease develop perianal fistulas which can be quite troublesome. A combination of surgical techniques such as seton placement, fistulotomy, fistulectomy, fistula plug treatment and laser treatment are available with our experts in colorectal surgery in Dubai.

2. Colon and Rectal cancer

Colon cancer is cancer of the large intestine and rectal cancer is cancer of the last part of the colon. Together, they are referred to as colorectal cancer. Colorectal cancer is a very common cancer above the age of 50 years. Early colon cancer does not cause any symptoms and hence can easily get missed. As the cancer grows it produces one or more of the following symptoms:

• Change is bowel habits (usually constipation or urgency)
• Blood in stools
• Pain in abdomen and lower back
• Anaemia (low level of hemoglobin) – this causes tiredness and easy fatigue
• Weight loss
• Abdominal distension and vomiting (if cancer blocks the intestine)

Screening

Colon cancer develops from polyps. Screening is used to detect large polyps which can be removed before they turn into cancer. Screening has been shown to decrease colon cancer remarkably. The best screening tool is a Colonoscopy once every 10 years after the age of 50 for all individuals. Polyps that are detected during colonoscopy can be removed at the same time. Screening colonoscopy is a simple procedure and you can contact our expert gastroenterologist in Dubai for more information. Patient who do not wish to undergo colonoscopy should test their stools for occult blood once a year. Occult blood testing is however, less effective than colonoscopy in detecting polyps and early cancer. If occult blood is found to be positive, colonoscopy will be required for further evaluation.

Diagnosis

Once colon cancer is suspected based on symptoms or a positive stool test, it is important to have a colonoscopy t locate the tumour and take biopsies. Once the biopsy confirms the tumor, further tests are done to make sure that the tumour has not spread to other parts of the body. These include a CT or a MRI scan. A special blood test called CEA (tumour marker) is also done.

Treatment

Colorectal cancer is well treatable disease. Patients who have cancer limited to the colon actually get cured after surgery. Even for patients in whom cancer has spread beyond the colon to the lymph glands and liver, there is modern targeted chemotherapy which is very effective. In Dubai and U.A.E. our colon cancer experts can provide you the best treatment. We have a multidisciplinary team of doctors and a tumour board with experts in cancer from all over the U.A.E. Each case is evaluated and discussed in detail in the tumour board and only then is a comprehensive treatment plan made.

“Our group also has one of the largest experience in laparoscopic surgery for colon cancer in U.A.E.”

Following are the types of surgery done depending on the site of cancer:

Laparoscopic Hemicolectomy: Depending on the site of the cancer, the right or the left halves of the colon can be removed. Our surgery experts in Dubai do all these surgeries laparoscopically. This reduces the recovery period and there are no scars on the belly.

Laparoscopic low anterior resection: This is an advanced laparoscopic surgery when the cancer is in the upper part of the rectum. After removal of the left lower colon and rectum, the remaining colon is joined to the anal canal so that the patient can pass stools in the natural manner.

Abdominoperineal excision: This surgery is done for cancers which are quite low down in the rectum. In addition to the rectum, the anal canal also needs to be removed in these cases. It is not possible to join the remaining colon to the anal canal and patient needs a permanent colostomy which is attached to a bag in which stools collect. We help all our patients understand how to take care of the stoma. We have best trained stoma care nurses who assist patients even after discharge from the hospital.

Colonoscopy and Endoscopic Mucosal Resection: If the cancer is detected in its very early stages and is limited to the innermost lining of the colon (mucosa), then it can be removed by colonoscopy itself without the need for an external surgery. This technique is performed only by our colon cancer treatment experts in U.A.E.

Resection of Liver Metastases: Colon cancer is one of those cancers in which even if it has spread to the liver, it can be removed surgically. Both the primary tumour in the colon and the deposits in liver can be removed. More than one surgery may be required. These techniques are usually combined with chemotherapy.

Chemotherapy: Chemotherapy uses drugs to destroy cancer cells. In colorectal cancer, chemotherapy may be given before or after the surgery. Chemotherapy is generally given when is suspicion that the cancer may have spread outside the colon to the lymph glands or other areas. Chemotherapy reduces the risk of recurrence of cancer. If chemotherapy is used before surgery, it reduces the size of the tumour and improves the result of surgery. Our colorectal cancer treatment team liaises with oncologists who will guide you for chemotherapy.

Radiotherapy: This uses powerful X-rays to kill cancer cells. It is generally used after surgery in cases of rectal cancer. It is often used in combination with chemotherapy for better results.

Post-surgery, regular follow-up care is imperative to help preserve good health and to manage side effects of the treatment. The most important reason for follow-up care is to watch for signs of cancer recurrence. If recurrence is detected early, it can also be well managed with modern chemotherapy drugs.