Health-Related Quality of Life after Ileal J-Pouch?Anal Anastomosis for Ulcerative Colitis: Long-Term Results

Abstract

Background: This questionnaire study examined associations between health-related quality of life and long-term follow-up results with J-pouch-anal anastomosis for ulcerative colitis. Methods: A two-part questionnaire was sent to patients treated for ulcerative colitis by handsewn J-pouch-anal anastomosis at our institute in the period 1985-95. The health-related quality of life measurement was based on a RAND SF-36 Finnish version of the questionnaire. Scores were compared with the normal Finnish population. The functional status was analysed with a 34-item questionnaire on pouch function and incontinence. Results: The response rate was 62%. The median follow-up time was 8 years (3 to 13 years). Functional results were acceptable: median number of bowel movements per 24 h was six. Soiling at night occurred in 32%, and inability to differentiate pouch contents in 24% cases. Twenty-four per cent used a pad occasionally, and 9% every day. The functional score and the health-related quality of life score correlated strongly. Poor functional status and a history of chronic pouchitis were associated with lower score. The limiting value after which the score was lower was 10 bowel movements per 24 h in 16%. A compromised anal continence proved to decrease the health-related quality of life as well. Conclusions: RAND SF-36 scores seem to provide a useful tool to evaluate the health-related quality of life after pelvic pouch operation for ulcerative colitis. Frequent bowel movements, impaired anal continence, and pouchitis are common in long-term follow-up after ileal pouch operation. The scores were, however, comparable to those in the normal population in terms of adaptation to daily life with a pelvic pouch.