307 Inflammatory Bowel Disease Patients on Immunosuppressive Therapy in Endoscopic Remission Have a High Rate of Post Inflammatory Bowel Disease-Irritable Bowel Syndrome Which is Associated With a Diminished Quality of Life

Abstract

of chronic immunosuppression to avoid colectomy. METHODS: Adult UC patients completed a mailed discrete-choice experiment survey with 9 treatment-choice questions that offered a choice of a hypothetical medication or surgical therapy with varying features. Medication features included improvement in disease activity, 10-year risk of dying from lymphoma and a serious infection, and risk of dying from colorectal cancer. Surgical features included having a J-pouch with/without incontinence or an ostomy, and 10-year risk of dying from a serious infection. Random parameters logit was used to estimate rates at which patients were willing to trade among treatment features in selecting surgery versus medication. RESULTS: 141 patients completed the survey. Avoiding surgery and surgery type (ostomy versus j-pouch) influenced patients' choices more than the risk of dying from lymphoma or infection, or severity of disease activity (mild vs. remission) over the ensuing 10 years. To avoid having an ostomy, patients were willing to accept >5% 10-year risk of dying from infection or lymphoma from medical therapy regardless of medication efficacy. However, patients were significantly less tolerant of medication risk if the surgical option was a Jpouch; and patients were equally satisfied with J-pouch surgery as with an incompletely effective medical therapy. Risk acceptability also varied significantly in certain subgroups: females were more tolerant of medication-related infection; patients ≥ 60 years old were less tolerant of surgery-related infection; patients with longer disease history were more willing to accept ostomy; and patients with a disease flare within the last year were less tolerant of lymphoma (all p-values <0.05). CONCLUSIONS: This study is the first to show that when faced with incompletely effective medical therapy, UC patients are willing to accept surgical options, specifically a J-pouch, with equivalent satisfaction. By discrete-choice methods, we were also able to identify specific subgroups of patients with increased/decreased willingness to accept surgical outcomes and severe medication adverse events. Taken together, these findings indicate that patients do not necessarily view surgery as an option of last resort and current treatment paradigms of exhausting all medical therapies may need to be reassessed. Table 1. Maximum Acceptable 10-Year Serious Adverse Event Risk for Selected Treatment Benefits to Avoid Surgery