Dr. Don Schiller - The Ileostomy Specialist
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Dr. Don Schiller has retired from his practice
involving BCIR and Kock Pouch surgery.

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Options for Ulcerative Colitis Treatment

October 27, 2014  ·  By: Dr. Don Schiller

For ulcerative colitis (UC) patients, life is often a series of painful episodes. Around 700,000 U.S. patients suffer from this chronic digestive disease, a form of inflammatory bowel disease, according to the Crohn’s Colitis Foundation of America (CCFA).

Overview of Ulcerative Colitis

Ulcerative Colitis (UC) is a chronic disease affecting the large intestine (colon). It typically waxes and wanes throughout life. Researchers link its development to a faulty autoimmune reaction. Inflammation arises in the lining of the colon, which eventually develops small, open sores. The most common symptoms include:

  • Looser bowel movements, often with greater urgency
  • Persistent diarrhea with pain, sometimes accompanied by bloody stools
  • Abdominal pain and cramping

The University of Maryland Medical Center indicates that as many as 20 percent of UC patients have a close relative with the illness.

Treatment Options

Patients have three general options for ulcerative colitis treatment:

  • Diet and nutrition:Avoiding foods that aggravate symptoms improves quality of life. Consuming small quantities also helps some patients.
  • Medication:Aminosalicylates, corticosteroids, immunosuppressants and biologic drugs suppress inflammation.
  • Surgery: The CCFAreports that between a fourth and a third of UC patients fail to respond to medical therapy. Removing the colon is the only cure for UC. This procedure is called a colectomy. After removing the colon and rectum, the surgeon creates an ileostomy to accommodate the passage of fecal waste.

Ileostomy Options

Ileostomies date to 1913, according to BCIRhistory.com. A surgeon pulls the end of the small bowel through an abdominal opening. Waste collects in a pouch, external or internal.

The Brooke ileostomy was developed in 1952 and is sometimes called the modern-day ileostomy. The surgeon carefully selects the location for the opening, or stoma, on the abdominal wall prior to surgery. A spout or nipple allows intestinal contents to flow into an external bag, avoiding skin contact. While many patients report a satisfactory quality of life, some experience poor function or hernias, leading them to seek other options.

Development of a continent ileostomy in 1969 provided an alternative. Over the years, the procedure was perfected and became known as the Koch pouch. Patients drained an internal pouch with a catheter. However, many required revisions or decided to revert to a permanent Brooke ileostomy.

Modifications by Dr. William O. Barnett created an improved version of the Koch pouch, the Barnett Continent Intestinal Reservoir (BCIR), and completed his final design by the late 1980s. It lowered the chance of developing a fistula and created a self-sealing valve. The design prevents slippage of the nipple valve. With this most recent type of ulcerative colitis treatment, individuals can easily insert a catheter in a restroom and drain the BCIR. For many UC patients, this ileostomy reversal is an important step in achieving their desired quality of life.

 

Retirement Announcement

Dr. Don Schiller has retired from his practice involving BCIR and Kock Pouch surgery. To find a surgeon who can help you, go to www.qla-ostomy.org and click on the tab Medical Info and you will see a Directory of all the surgeons in the country who perform Continent Ileostomy surgery.

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