Cleveland Global Quality Of Life Score Research Articles

A specific phenotype of pouchitis was associated with worst prognosis in patients with ulcerative colitis according to Chicago classification

BackgroundThe impact of different pouch phenotypes on long-term functional outcomes and quality of life (QoL) remains unclear. Our aim is to investigate the association between endoscopic pouchitis phenotypes and patients' long-term prognosis by assessing pouch function and QoL. MethodsPouchitis was classified into distinct phenotypes according to the Chicago Classification. Pouch function was assessed using the Pouch Functional Score (PFS), and QoL was evaluated using the Cleveland Global Quality of Life (CGQL) score. ResultsA total of 252 patients were enrolled in the study, with 78 patients diagnosed with pouchitis. According to the Chicago classification, 42 of these pouchitis patients exhibited an endoscopic phenotype characterized by a combination of diffuse inflammation of the pouch body, inlet involvement, and cuffitis, referred to as the Diffuse-Inlet-Cuffitis phenotype. Patients with pouchitis of the Diffuse-Inlet-Cuffitis phenotype showed significantly higher PFS (11.5 vs 5.5, p = 0.013) and lower CGQL scores (0.67 vs 0.7, p = 0.029) compared to those with other pouch phenotypes. Independent risk factors for this severe phenotype were identified as preoperative disease duration (OR = 1.062, 95% CI: 1.006–1.122, p = 0.030) and disease extent E3 (OR = 2.836, 95% CI: 1.052–7.644, p = 0.036). ConclusionsOur study suggested that pouchitis with the Diffuse-Inlet-Cuffitis endoscopic phenotype is common and seriously impairs the long-term prognosis in patients with UC after IPAA. The finding will be beneficial to the stratified management of patients with pouchitis.

DEFINING LONG-TERM QUALITY OF LIFE AND FUNCTIONAL OUTCOMES AFTER REDO ILEAL POUCH ANAL ANASTOMOSIS: WHAT SHOULD PATIENTS AND PROVIDERS EXPECT?

Abstract BACKGROUND Pouch failure after restorative proctocolectomy with ileal pouch anal anastomosis (IPAA) occurs in up to 15% of cases. A redo pouch procedure can be offered to maintain intestinal continuity after pouch failure, but little is known on quality of life (QoL) after redo pouch. We aimed to describe long-term QoL and functional outcomes after redo pouch. METHODS We retrospectively analyzed our prospectively collected redo pouch registry, and identified patients who had completed at least one Cleveland Global Quality of Life (CGQL) questionnaire after redo pouch. Figures are number (proportion) or median (interquartile range). RESULTS Out of 532 patients, CGQL were available for 375 (70%): 212 (57%) females, median age at redo pouch 40 (28 – 48) years. Diagnosis at index pouch was ulcerative colitis in 325 (87%) cases, indeterminate colitis in 13 (3%), Crohn’s disease in 15 (4%), familial adenomatous polyposis in 21 (6%). The median interval between index and redo pouch was 4 (2 – 6) years. The indication for redo pouch was sepsis in 230 (61%) cases, mechanical in 114 (31%), functional in 19 (5%), and dysplasia or cancer in 11 (3%). The anastomosis was handsewn in 72% cases. After redo pouch, 351 (95%) had their stoma closed, while 18 (5%) never had stoma closure due to complications, and 5 (1%) due to patient preference. The median interval between redo pouch and latest CGQL was 4 (1 – 9) years. The overall CGQL score (0 – 1) was 0.7 (0.5 – 0.8), with median quality of life 7 (5 – 9), quality of health 7 (5 – 8) and quality of energy 6.5 (5 – 8). There were no differences in CGQL scores in patients who had a redo pouch due to septic complications versus other indications. The median number of bowel movements was 6 (5 – 8) during the daytime, 2 (1 – 3) during the nighttime, for a total of 8 (6 – 10) bowel movements per 24 hours. Dietary restrictions were reported by 50% patients, social restrictions by 34%, work restrictions by 38%, and sexual restrictions by 37% (Figure 1). Urgency occurring daily or most days was reported by 24% patients, incontinence by 10%. Consistency of stool was reported as liquid by 76% of patients. Seepage during the day was experience by 52% of patients, nocturnally in 68%, with 53% of patients reporting daytime pad use, and 61% at night. Median happiness with surgery was 8 (5 – 10): 80% patients would undergo surgery again, and 84% patients would recommend it to other people. During follow-up, 84 (22.5%) pouch failures occurred. CONCLUSION A redo pouch procedure allows a majority of patients to maintain intestinal continuity with good quality of life. Most patients would undergo redo pouch again and recommend it to others. Before redo pouch, patients need to be counselled regarding function expectations in regards to stool frequency and consistency, urgency, incontinence, seepage, and overall success rates.

Impact on Quality of Life of Seton Placing in Perianal Crohn's Disease

IntroductionOften, in perineal Crohn's disease (CD), a seton is placed to guarantee a constant drainage and prevent septic complication while biologic therapy is ongoing. This study aimed to assess the long-term quality of life after surgery for perineal CD in relation to seton placing.Patients and MethodsData of 65 consecutive patients with CD and non-CD operated on from 2014 to 2019 for perianal fistula or abscess were retrieved. Forty-three had CD and 14 of them had a seton placed during surgery and they kept it on while they had anti-TNF-alpha therapy. Patients were interviewed with the Cleveland Global Quality of Life (CGQL) and SF-12 quality of life questionnaires. Disease activity was defined as Harvey-Bradshaw Index (HBI) and Perianal Disease Activity Index (PDAI). Comparisons between groups were carried out with the nonparametric tests, and multiple regression models were used to assess predictors of quality of life.ResultsThe total CGQL score and SF-12 mental component score (MCS) were significantly higher (and thus better) in the seton group than in patients treated without seton. On the contrary, SF-12 physical component score (PCS) was not different between the two groups. HBI was significantly better in patients in the seton group. At multivariate analysis, seton placement and HBI were confirmed to be independent predictors of long-term SF-12 MCS whereas only HBI confirmed to be a predictor of total CGQL score.ConclusionsSeton placing during anti-TNF-alpha therapy is independently associated with a better MCS. Unexpectedly, this device, instead of to cause psychological distress, seems to assure patients during their biologic therapy providing psychological benefit beyond the mere medical effect.

Impact of surgery on quality of life in Crohn's disease: short- and mid-term follow-up.

Active Crohn's disease has a substantial impact on Quality of Life (QoL). Medical management could be associated to side effects, hospitalization, long treatment period and requires patient's compliance, impacting QoL. Ileocecal resection (ICR) is often required, open or laparoscopic. Aim of the study was to assess Health-Related (HR) QoL changes following ICR, and to identify factors impacting on QoL in the short and mid-term. From a single institution, we created a prospective database of patients undergoing ICR from 01/2009 to 12/2015. HRQoL was analysed with Cleveland Global Quality of Life (CGQL) score, Overall Quality of Happiness (OQH), and asking patients if they would have surgery again. QoL scores were recorded at 30days, 6, 12 and 36months postoperatively and compared according to follow-up timing, technique, medical treatment and demographics. Statistical analysis included 187 patients. Mean follow-up was 3.8 ± 2.9years. Both at 30days and 6months postoperatively, CGQL, its items and OQH increased significantly (p < 0.001). Increased values were also recorded at 1 and 3years; 88% of patients would undergo surgery again. Laparoscopy was associated with improved CGQL scores, while preoperative steroids with worsen data. Young female patients, with penetrating pattern, experienced greater HRQoL improvements. Surgery is associated with improvements of HRQoL and patients' happiness in the short and mid-term. Laparoscopy, steroid-free and young patients showed the best results. ICR should be considered a reasonable alternative to non-operative strategies in selected cases.

P048 QUALITY OF LIFE AND OTHER PATIENT REPORTED OUTCOMES IN PATIENTS WITH POUCHITIS

Abstract Background While restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the preferred surgical approach in patients with medically refractory ulcerative colitis (UC) or UC-related dysplasia, a significant proportion of patients develop pouchitis and/or report decreased health related quality of life (HRQOL) at some point after IPAA. We designed this study to 1) evaluate the association between recently reported pouchitis and specific Patient-Reported Outcome Measurement Information System (PROMIS) domains (anxiety, depression, fatigue, pain interference, sleep disturbance, and social role satisfaction) and HRQOL as assessed by the Cleveland Global Quality of Life (CGQL) scale, and 2) describe the correlations between specific PROMIS domains and overall HRQOL. Methods IBD Partners is an internet-based cohort that collects patient reported survey data every 6 months. In patients who reported having an IPAA for UC, we performed cross sectional analyses to compare patient characteristics and patient reported outcomes among patients who reported pouchitis in the prior 6 months versus those without reported pouchitis. To identify the specific social, emotional, and physical domains most associated with HRQOL, we evaluated the correlations between PROMIS domains (measured in T-scores) and CGQL scores using Pearson’s test. Results Among 118 patients, 70 (59%) reported pouchitis in the prior 6 months. There were no significant differences in age, sex, race, or number of stages of IPAA between patients with and without recent pouchitis (Table 1). Patients with recent pouchitis were more likely to demonstrate higher levels of anxiety (53.8 vs. 48.5, p=0.005), depression (52.2 vs. 46.9, p=0.005), fatigue (55.8 vs. 47.8, p&amp;lt;0.001), pain interference (54.4 vs. 48.1, p=0.001), sleep disturbance (54.3 vs. 48.8, p=0.001), and lower levels of social satisfaction (47.4 vs. 53.6, p=0.001). As assessed by the CGQL, patients with pouchitis demonstrated decreased Quality of Life (6.64 vs. 7.71, p=0.007), Quality of Health (6.31 vs. 7.63, p=0.001), and Quality of Energy (5.77 vs. 7.17, p=0.001). Social satisfaction was the PROMIS domain that most strongly correlated with Quality of Life among patients with recent pouchitis (r= 0.62, Table 2) while sleep demonstrated the strongest correlation among those without pouchitis (r= -0.74). Conclusions Patients with recent pouchitis demonstrated a significant reduction in overall HRQOL as well as decrements in specific areas of social, emotional, and physical health. Among patients without pouchitis, strong correlations between multiple PROMIS domains and HRQOL were also demonstrated. These findings indicate that the PROMIS measures may be useful in assessing these areas of health that are clinically important after IPAA, allowing for tailored interventions in this population.

P442 Long-term quality of life after surgery for perianal Crohn’s disease

Abstract Background Perianal disease is rather common among Crohn’s disease (CD) patients and quality of life is often worsened by disease activity. This study aimed to assess the possible predictors of long-term quality of life after surgery for perineal CD. Methods Data of 50 consecutive patients operated on from 2014 to 2018 for perianal fistula or abscess were retrieved. Thirty-three of them had perianal CD while 17 of them had a sporadic perianal fistula and were enrolled as controls. Patients were interviewed with the Cleveland Global Quality of Life (CGQL) and SF-12 quality of life questionnaires. Disease activity was defined as the Harvey–Bradshaw Index (HBI) and Perianal Disease Activity Index (PDAI). Comparisons between CD and sporadic groups were carried out with non-parametric tests and log-rank test and multiple regression models were used to assess predictors of quality of life. Results The total CGQL score and that of all its items were significantly lower in CD patients compared with patients with the sporadic perineal disease (p &amp;lt; 0.05) while SF12 sub total did not differ in the two groups. At multivariate analysis, CD diagnosis and perineal disease activity index confirmed to be independent predictors of long-term overall quality of life measured with CGQL. SF-12 mental component (MCS) was predicted by PDAI (p = 0.005) and by HBI (p = 0.03) while SF-12 Physical Component (PCS) was independently predicted by PDAI (p = 0.008), oozing perineal fistulae (p = 0.01) and age at disease onset (p = 0.0003). Conclusion Long-term quality of life after surgery for perineal disease is worse in CD patients than in patients with sporadic perianal disease. Quality of life is predicted by local and systemic disease activity and age at disease onset.

P533 Long-term quality of life after minimally invasive surgery for Crohn’s disease

Abstract Background Risk of surgery is among the highest-rated concerns among Crohn’s disease (CD) patients. Quality of life is often worsened by intestinal surgery. This study aimed to assess the possible predictors of long-term quality of life after minimally invasive surgery for ileal, colonic or ileocolonic CD. Methods Data of all the 72 consecutive patients operated from 2010 to 2018 for CD were retrieved and 72 patients who had ileal, colonic or ileocolonic resection were selected and interviewed with the Cleveland Global Quality of Life (CGQL) questionnaire and the Body Image Questionnaire (BIQ). Disease activity was defined as the Harvey–Bradshaw Index (HBI). Comparisons between laparoscopic and open groups were carried out with non-parametric tests and log-rank test. Results Seventy-two patients who had laparoscopic ileal, colonic or ileocolonic resection and had a follow-up greater than 1 year were interviewed. The total CGQL score was associated with clinical disease activity at the moment of the interview (rho = −0.61, p &amp;lt; 0.0001) and to the presence of extraintestinal complication (rho = 0.28, p = 0.03). At multivariate analysis, disease activity at the moment of the interview and the presence of extraintestinal complication confirmed to be independent predictors of long-term quality of life. Conclusion Long-term quality of life after minimally invasive intestinal surgery is essentially predicted by current disease activity. Thus, it is crucial to prevent clinical CD recurrence

P629 Impact of surgical treatment on quality of life in Crohn’s disease: Short-and longer-term follow-up

Symptoms of active CD have a substantial impact on health-related quality of life (HRQoL). Even in the absence of active disease, CD patients report worse HRQoL. Achievement of disease remission, whether by medical therapies or surgery, is associated with an improvement of quality of life (QoL). Medical management not rarely is associated to side effects, hospitalisation, long treatment period and requires patient compliance, with impact on QoL. Surgery is often required, in the form of ileo-colic resection (ICR), open or laparoscopic. Aim of the study was to assess changes of QoL following ICR, and to identify specific factors, patient and disease-related, impacting on QoL in the short- and longer term. We analysed data from a prospective database of patients undergoing ICR from 01/2009 to 08/2017. Data included duration of CD, disease features, demographics, habits and comorbidities. We assessed medical therapies before surgery (steroids/biologics), open and laparoscopic technique. Quality of life (QoL) was analysed with the Cleveland Global Quality of Life (CGQL) Score, recording the three items: Current Quality of Life (CQoL), Current Quality of Health (CQoH), Current Energy Level (CEL). In addition, the Overall Quality of Happiness (OQH) was recorded and patients answered the question if they would have surgery again and/or they recommend the treatment to others. CGQL Scores and OQH were compared according to timing of follow-up, surgical technique, medical treatment, and demographics. One hundred and thirteen patients were considered for analysis. Demographics and pre-operative data were similar among the groups. Fifty-two (46%) patients had laparoscopy and 61 (54%) laparotomy. Both at 30 days and 6 months after surgery we observed a significant increase of CGQL (p < 0.0001). Incremental values were also recorder at 1 and 3 years with a minor increase. Significant improvement was observed in all the three items composing the CGQL (p < 0.0001). This was also confirmed from the OQH. 88% of patients would undergo surgery again or recommend it. Laparoscopy was associated with better CGQL scores. Steroids before surgery showed a significant minor improvement in CGQL. Positive factors for QoL improvements were young age, female gender, penetrating disease. QoL of patients with CD is lower than normal ranges. Medical treatments often are not able to keep symptoms under control, and surgery is required. Surgical treatment is able to remove the diseased bowel, and is associated with a clear improvement of all the items related with QoL. Laparoscopy seems to guarantee greater results.

Post-operative outcome following ileal pouch-anal anastomosis (IPAA)

Background IPAA procedure is the surgery of choice in severe ulcerative colitis (UC) and familial adenomatous polyposis (FAP). The objectives of the study were to assess symptomatic improvement, complications, effect on sexual function and quality of life (QOL) following IPAA procedure. Methods Twenty one patients who underwent IPAA procedure at a tertiary care unit with a minimum of one year follow-up from 2009, were included. QOL was assessed retrospectively prior to surgery and one year after surgery using Cleveland Global Quality of Life Score (CGQLS). Details of pre and post-op symptoms, complications and sexual function were obtained using clinical records, operative notes and interviewer administered questionnaire. Results Male: female ratio was 1.33:1. Fourteen (66.7%) were sexually active and seven (33.3%) were not. Mean age was 40.48(range, 17-69) years. 13(61.9%) had UC and 8(38.1%) had FAP. Mean pre-op CGQL scores for UC and FAP were 0.5754 and 0.7537 respectively. Post-op CGQLS for UC and FAP were 0.7532 and 0.7070. There was no statistically significant difference between CGQL scores against the indication for surgery (P=0.779). Stool frequency was significantly reduced in UC (pre-op=12.4, post-op=5.2 per day, p=0.004) but no difference in FAP (pre-op=2.6, postop= 3.5 per day, p=0.292). Post-operatively, one patient developed erectile dysfunction and another patient developed dyspareunia. Conclusion There is no significant difference of CGQL scores following IPAA procedure in relation to the surgical indication. IPAA significantly reduced stool frequency per day in UC but not in FAP. Erectile dysfunction and dyspareunia are possible sexual dysfunctions following IPAA procedure.

Quality of life, social impact and functional outcome following ileal pouch-anal anastomosis for ulcerative colitis and familial adenomatous polyposis.

This study aims to assess quality of life (QoL), functional outcome, and social impact following ileal pouch anal anastomosis (IPAA) for ulcerative colitis (UC) and familial adenomatous polyposis (FAP) since Indian data is limited. Data was collected prospectively from patients who underwent IPAA for UC or FAP from 2004 to 2013. QoL and functional outcome at 1, 3, and 5 years after surgery, return to work, and change of job (social impact) were documented. QoL was assessed using the validated Cleveland Global Quality of Life (CGQL) score, the normal score being 1.0. Twenty-five patients were analyzed. Mean CGQL scores before surgery and at 1, 3, and 5 years were 0.5, 0.63, 0.73, and 0.8, respectively. FAP patients had better scores at 3 and 5 years. Only 40 % returned to same job. Sixty-four percent returned to work within a year. The median number of bowel movements per 24 h was less for FAP patients at 3 and 5 years. UC patients on long-term steroids had poorer function at 3 years. Long-term QoL and functional outcomes following IPAA are acceptable. Initial deterioration in QoL, mainly in FAP and long-term adverse social impact in both groups should not be underestimated. UC patients on long-term steroids showed delayed improvement in pouch function.

Functional outcome and quality of life following restorative proctocolectomy for ulcerative colitis in Indians

The functional outcome and quality of life after sphincter-saving operations for ulcerative colitis have not been previously assessed in Indian patients whose dietary habits and socio-cultural practices differ considerably from those in western countries. Between 1996 and 2002, we performed 46 J-pouch ileoanal anastomoses (IPAA), for patients with ulcerative colitis. Thirty-eight of these patients had had their ileostomy closure more than 4 years previously of whom 31 could be assessed by interviews and a telephonic questionnaire. Their quality of life was objectively assessed using the Cleveland Global Quality of Life (CGQL) index, a validated index for IPAA, the score being 1 in normal people. There were 20 males and 11 females with a mean age of 38 years. In the same period, six of the nine patients who did not opt to have an IPAA (permanent stoma) were assessed. These included four males and two females, mean age 45 years (36-52). One patient died in the postoperative period and another died 3 months after surgery from multiple small bowel perforations. Other complications included intestinal obstruction in seven, pouchitis in four and incisional hernia in two. One pouch had to be converted to a permanent ileostomy following development of a fistula because of Crohn's disease. The mean daily postoperative stool frequency was seven (range 2-20). Eighty-one percent had perfect daytime continence and 81% used dietary restrictions. Eighty-four percent rated their pouch function to be excellent or good. All patients preferred IPAA to an ileostomy citing mainly social and cultural reasons and were willing to choose it again. The mean preoperative CGQL score (0.27) increased significantly after colectomy (0.50) and after closure of ileostomy (0.77; p < 0.001). The mean CGQL in the "permanent stoma" group did not improve significantly after surgery (0.62 vs. 0.50) and four of these expressed a wish to have an IPAA. Restorative proctocolectomy provides a good functional outcome and improves the quality of life in Indians with ulcerative colitis and may be the most appropriate procedure for such patients in developing countries.

Development of a pouch functional score following restorative proctocolectomy

The influence of function on quality of life after primary restorative proctocolectomy (RPC) was determined with the aim of developing a pouch functional score. The Cleveland Global Quality of Life (CGQL) score was determined in 4013 patients undergoing RPC between 1977 and 2005 (mean(s.d.) follow-up 7.0(5.1) years; 13 105 follow-up episodes). Linear regression analysis was used to identify independent symptom domains of function as possible predictors of quality of life to develop and validate a pouch functional score. CGQL scores at 1, 5, 10, 15 and 20 years were 85.0, 87.5, 87.5, 85.0 and 82.5 respectively (P = 0.001). On multivariable analysis, the symptom domains of stool frequency (24 h, nocturnal), urgency, incontinence and medication (antidiarrhoeals, antibiotics) were independently associated with CGQL (P < 0.001). The beta coefficients within each symptom domain were then adjusted to create a scale of 0-30 for practical use, the Pouch Functional Score (PFS), which correlated with the CGQL score (r(s) = -0.47, P < 0.001). Stool frequency, urgency, incontinence and need for medication are major determinants of quality of life following RPC. The PFS demonstrated good correlation with CGQL.

Comparison of outcomes after hand-sewn versus stapled ileal pouch-anal anastomosis in 3,109 patients

The aim of this study was to compare outcomes after primary hand-sewn versus stapled ileal pouch-anal anastomosis (IPAA). Patients undergoing a primary IPAA (1983-2007) were identified from a prospective pelvic pouch database. Differences between group A (hand-sewn) and group B (stapled) for pre-operative and peri-operative factors, complications, functional outcomes, and quality of life (QOL) were investigated. Of 3,382 patients with a primary IPAA, 3,109 were included. Median follow-up was 7.1 years (0.1-24). Mean age was 37.9 +/- 13.2 years. Overall, 1,741 patients (56%) were male. Group A (n = 474) and group B (n = 2635) had similar age (P = .28), sex (P = .8), albumin level (P = .74), prior colectomy (P = .98), and use of steroids (P = .1). Group A had a greater use of ileostomy (P = .001) and a longer duration of stay (P < .001). Group B had a greater body mass index (P < .001) and J-pouch (P < or = .001). Wound infection (P = .42) and pouchitis (P = .59) were similar. Anastomotic stricture (P = .002), septic complications (P = .019), bowel obstruction (P = .027), and pouch failure (P < .001) were greater in group A. At most recent follow-up, bowel frequency (P = .74) and rate of urgency were similar (P = .71). A greater proportion of patients in group A described incontinence (P < .001), seepage (P < .001), pad usage (P < .001), dietary (P < .001), social (P < .001), and work restrictions (P = .025). The Cleveland Global QOL score (P = .018) was greater in group B. Patients undergoing a stapled IPAA had better outcomes and QOL than those undergoing a hand-sewn IPAA.

Restorative proctocolectomy for inflammatory bowel disease

In 10-20% of cases, it is impossible to distinguish between ulcerative colitis and Crohn's colitis, affecting the possibility to predict the long-term outcome after restorative proctocolectomy (RPC). The study aimed to assess the accuracy of a new prognostic score for inflammatory bowel diseases (IBD) colitis [the Padova Prognostic Score for Colitis (PPSC)] in predicting long-term clinical/functional outcome and quality of life after RPC. The PPSC was created by the integration of histological and clinical information. The accuracy of the PPSC was tested in predicting long-term clinical outcome (i.e. pouch complications/survival) and quality of life of 58 consecutive patients who had undergone RPC in our institute from 1984 to 2004. Clinical outcome was assessed with an ad hoc functional questionnaire and the revision of the hospital and outpatients clinic notes. Quality of life surveys were carried out with the Padova IBD Quality of Life (PIBDQL) and with Cleveland Global Quality of Life (CGQL) scores. The PPSC predicted pouch fistulae (accuracy = 84.5%; sensitivity = 50%; specificity = 90%) and changes in sexual life (accuracy = 71%; sensitivity = 23%; specificity = 87%). The PPSC also predicted the PIBDQL score with an accuracy of 62%, a sensitivity of 28% and a specificity of 97%, whilst it predicted the CGQL score with an accuracy of 29%, a sensitivity of 12% and a specificity of 80%. The PPSC failed to predict pouchitis or pouch failure. The Padova Prognostic Score for Colitis proved effective in predicting pouch fistulae or abscesses, but not pouchitis and pouch failure. The PPSC was accurate in predicting disease-specific quality of life.

Ileal Pouch Rectal Anastomosis: A Viable Alternative to Permanent Ileostomy in Crohn's Proctocolitis Patients

Ileal pouch rectal anastomosis (IPRA) is a possible alternative to permanent ileostomy when a short, normal-appearing rectal stump remains after total colectomy. Its outcomes in Crohn colitis (CC) patients have not been reported. CC patients who underwent IPRA from 1992 to 2004 were identified. Operative and morbidity data were collected. Functional outcomes and quality-of-life (QOL) data were obtained using a mailed questionnaire and compared with matched patients who underwent straight ileorectal anastomosis (SIRA). Twenty-three CC patients underwent IPRA. Perioperative complications included three pelvic septic fluid collections and five small bowel obstructions or ileus, and were treated nonoperatively. Twenty-two patients were available for longterm followup (median 98 months). Fourteen patients (64%) had disease recurrence. Two (9%) have lost a functioning anastomosis. Nine (41%) required additional operations. Matched SIRA patients had higher level of anastomosis (23.4 +/- 5.5 versus 9.0 +/- 4.1 cm above the dentate line; p < 0.0001). Bowel movement frequency (median 6.5/24 hours in both groups), incontinence, and urgency rates were similar. Nighttime seepage and pad usage were more frequent in IPRA. No differences were found in QOL parameters (Cleveland Global QOL score: 0.78 versus 0.73 [0 = worst, 1 = best], IPRA versus SIRA, respectively; p = 0.31). All patients with a functioning IPRA stated they would have their operation again if needed, and 94% would recommend it to others. IPRA offers durable preservation of bowel continuity and good function and QOL in selected CC patients who might otherwise require a permanent ileostomy.

Quality of Life After Restorative Proctocolectomy for Ulcerative Colitis

According to some researchers, health-related quality-of-life scores for patients who undergo restorative proctocolectomy (RPC) for ulcerative colitis (UC) are comparable to those of healthy control subjects. Other studies show evidence that patients who undergo RPC experience a health-related quality of life similar to patients with mild UC or UC in remission. The discrepancy in health-related quality-of-life scores among studies may be due to different health-related quality-of-life analyses. Cross-sectional study. Outpatient clinic of a tertiary care center. In the first phase of the study, we consecutively enrolled 24 patients with UC, 24 patients with Crohn disease, and 24 healthy controls. In the second phase of the study, 40 patients who underwent RPC, 43 patients with UC, and 44 controls were consecutively enrolled. We administered an Italian version of the Cleveland Global Quality of Life (CGQL) instrument, the Padova Inflammatory Bowel Disease Quality of Life instrument, and the Italian 36-Item Short-Form Health Survey. We evaluated the construct validity, internal consistency, test-retest reliability, sensitivity to change, and discriminant ability of the Italian CGQL instrument. We compared its discriminative ability with that of the Padova Inflammatory Bowel Disease Quality of Life instrument. The Italian CGQL instrument obtained good construct validity, internal consistency, test-retest reliability, and sensitivity to change. The Italian CGQL score did not distinguish patients who underwent RPC from healthy controls and those with mild UC or UC in remission, while the Padova Inflammatory Bowel Disease Quality of Life instrument reported similar scores for patients who underwent RPC and those with mild UC or UC in remission, and showed a difference vs healthy controls. We validated an Italian version of the CGQL score. The different results obtained with the CGQL and the Padova Inflammatory Bowel Disease Quality of Life instruments can be attributed to the different discriminative ability of the 2 questionnaires.

Health-Related Quality of Life after Ileocolonic Resection for Crohnʼs Disease: Long-term Results

Crohn's disease (CD) is a chronic illness that interferes with the daily life of those affected. The aim of the present study was to evaluate long-term health-related quality of life (HRQL) outcome and its clinical predictors in CD patients who have had ileocolonic resection. Ninety-seven CD patients, with a mean follow-up of 47.1 months (95% CI, 40.7-53.5 months) after ileocolonic resection, were interviewed by telephone and responded to the generic Cleveland Global Quality of Life (CGQL) questionnaire, and 63 of them also agreed to come to our outpatient clinic to have a Crohn's Disease Activity Index (CDAI) assessment and blood test and to answer the disease-specific Padova Inflammatory Bowel Diseases Quality of Life (PIBDQL) questionnaire. Control groups also were enrolled. The CGQL scores of the 97 CD patients were similar to those of 69 healthy controls. Only the item on current quality of health was scored significantly lower by patients with CD. In contrast, the PIBDQL item and total scores of the CD patients were all significantly lower than those of the respective healthy controls (P < 0.05). Multivariate analysis showed that the CGQL and PIBDQL scores both had a strong linear relationship with number of daily stools and with CDAI score (P < 0.05). Despite CD patients who have undergone ileocolonic resection having an apparently normal quality of life with a good energy level, as shown by the CGQL, their long-term HRQL is still affected by a significantly impaired quality of health. In fact, the PIBDQL questionnaire showed significant impairment of bowel and systemic symptom domains with important consequences for emotional and social functions. HRQL seems to be significantly related only to current disease activity.

Prospective assessment of Cleveland Global Quality of Life (CGQL) as a novel marker of quality of life and disease activity in Crohn’s disease

Objective The Short Form 36 (SF-36) questionnaire is the most widely accepted measure of quality of life (QOL); however, it is cumbersome to use and requires complicated analysis. The Cleveland Global Quality of Life (CGQL) is a simpler tool, which has been validated in patients with ulcerative colitis undergoing restorative proctocolectomy. This study validates CGQL in patients with Crohn’s disease and determines the correlation of QOL measurement systems with disease activity as measured by the Crohn’s Disease Activity Index (CDAI). Methods All patients with Crohn’s disease presenting to this department between September 2001 and February 2002 were prospectively entered into a database, including demographic data, disease manifestations, Vienna classification, age at diagnosis, and duration of Crohn’s disease. SF-36, CGQL, and CDAI scores were entered concurrently. Cronbach’s α was used to assess the internal consistency among the components of the CGQL score. Correlation among various QOL measures was assessed with Spearman’s test. Relationships between QOL measures and various baseline factors were assessed by Wilcoxon rank sum test, Student’s t test, Kruskal–Wallis test, and Pearson’s test, depending on the type and distribution of data. Change from baseline in the CGQL was assessed with the Wilcoxon signed rank test. Results One hundred seventy-eight (178) patients were entered into the database, and 169 completed QOL and CDAI data. There was a significant correlation between SF-36 and CGQL. CGQL and SF-36 correlated similarly with CDAI. Neither patient age, gender, or smoking history were associated with CGQL. Conclusions CGQL correlates with disease activity and is a simple measure of QOL in Crohn’s disease.

Prospective assessment of Cleveland Global Quality of Life (CGQL) as a novel marker of quality of life and disease activity in Crohn's disease.

The Short Form 36 (SF-36) questionnaire is the most widely accepted measure of quality of life (QOL); however, it is cumbersome to use and requires complicated analysis. The Cleveland Global Quality of Life (CGQL) is a simpler tool, which has been validated in patients with ulcerative colitis undergoing restorative proctocolectomy. This study validates CGQL in patients with Crohn's disease and determines the correlation of QOL measurement systems with disease activity as measured by the Crohn's Disease Activity Index (CDAI). All patients with Crohn's disease presenting to this department between September 2001 and February 2002 were prospectively entered into a database, including demographic data, disease manifestations, Vienna classification, age at diagnosis, and duration of Crohn's disease. SF-36, CGQL, and CDAI scores were entered concurrently. Cronbach's alpha was used to assess the internal consistency among the components of the CGQL score. Correlation among various QOL measures was assessed with Spearman's test. Relationships between QOL measures and various baseline factors were assessed by Wilcoxon rank sum test, Student's t test, Kruskal-Wallis test, and Pearson's test, depending on the type and distribution of data. Change from baseline in the CGQL was assessed with the Wilcoxon signed rank test. One hundred seventy-eight (178) patients were entered into the database, and 169 completed QOL and CDAI data. There was a significant correlation between SF-36 and CGQL. CGQL and SF-36 correlated similarly with CDAI. Neither patient age, gender, or smoking history were associated with CGQL. CGQL correlates with disease activity and is a simple measure of QOL in Crohn's disease.