How does surgical therapy relate to disease in UC versus Crohn's disease?

• A. In Crohn's disease, colectomy can be curative
• B. In ulcerative colitis, colectomy can be curative for colitis; in Crohn's disease, surgery is not curative and is for complications or failure of medical therapy
• C. Surgery cures both
• D. Surgery is never used

Answer: (B)

Surgical therapy has curative potential in ulcerative colitis but not in Crohn's disease. Ulcerative colitis is confined to the colon and typically affects the mucosal lining in a continuous pattern from the rectum. Removing the entire colon and rectum eliminates the diseased tissue, so the intestinal disease is cured, with the option of reconstructive procedures like an ileal pouch-anal anastomosis to preserve continence.

Crohn's disease, on the other hand, can affect any part of the GI tract and involves full-thickness inflammation with skip lesions. Even after removing a diseased segment, the disease often recurs elsewhere in the remaining bowel, so surgery is not curative. In Crohn's, surgery is used mainly to treat complications (such as strictures, obstructions, fistulas, or abscesses) or to relieve symptoms when medical therapy fails.