Cleveland Global Quality Of Life 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.

Functional outcomes after transanal ileal pouch-anal anastomosis for ulcerative colitis: narrative review of the current literature.

The transanal approach to ileal pouch-anal anastomosis (Ta-IPAA) for ulcerative colitis was introduced in 2015 and has since been shown to be a safe and feasible technique, although the impact of this approach on patient function remains unclear. A systematic literature review was performed to identify studies exploring functional outcomes and quality of life after Ta-IPAA. Seven papers were identified, which all demonstrated satisfactory functional outcomes after Ta-IPAA as measured by tools such as Cleveland Global Quality of Life (CGQOL), Oresland Score (OS), Pouch Functional Score (PFS), and Inflammatory Bowel Disease Questionnaire (IBDQ). Many gaps in the literature were identified including paucity of follow-up data beyond the 1-year mark, lack of fertility and fecundity assessment as functional outcomes, and limited evaluation of objective physiologic anal sphincter function. The Ta-IPAA therefore shows promise for good functional results in the short-term, although further research will be required to evaluate the stability of function over time as the technique becomes increasingly integrated into modern surgical practice.

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.

Long-term outcomes after close rectal dissection and total mesorectal excision in ileal pouch-anal anastomosis for ulcerative colitis

BackgroundDuring ileal pouch-anal anastomosis (IPAA) surgery for ulcerative colitis (UC), rectal dissection can be performed via close rectal dissection (CRD) or in a total mesorectal excision plane (TME). Although CRD should protect autonomic nerve function, this technique may be more challenging than TME. The aim of this study was to compare long-term outcomes of patients undergoing CRD and TME.MethodsThis single-centre retrospective cohort study included consecutive patients who underwent IPAA surgery for UC between January 2002 and October 2017. Primary outcomes were chronic pouch failure (PF) among patients who underwent CRD and TME and the association between CRD and developing chronic PF. Chronic PF was defined as a pouch-related complication occurring ≥ 3 months after primary IPAA surgery requiring redo pouch surgery, pouch excision or permanent defunctioning ileostomy. Secondary outcomes were risk factors and causes for chronic PF. Pouch function and quality of life were assessed via the Pouch dysfunction score and Cleveland global quality of life score.ResultsOut of 289 patients (155 males, median age 37 years [interquartile range 26.5–45.5 years]), 128 underwent CRD. There was a shorter median postoperative follow-up for CRD patients than for TME patients (3.7 vs 10.9 years, p < 0.01). Chronic PF occurred in 6 (4.7%) CRD patients and 20 (12.4%) TME patients. The failure-free pouch survival rate 3 years after IPAA surgery was comparable among CRD and TME patients (96.1% vs. 93.5%, p = 0.5). CRD was a no predictor for developing chronic PF on univariate analyses (HR 0.7 CI-95 0.3–2.0, p = 0.54). A lower proportion of CRD patients developed chronic PF due to a septic cause (1% vs 6%, p = 0.03).ConclusionsAlthough differences in chronic PF among CRD and TME patients were not observed, a trend toward TME patients developing chronic pelvic sepsis was detected. Surgeons may consider performing CRD during IPAA surgery for UC.

Physical Activity, Quality of Life, and Nursing Workload in Colorectal Surgery

Postoperative recovery depends on a complex interplay of patient-related factors of which mobility is an essential part. The aim of this study is to evaluate correlations between perioperative physical activity, quality of life, and postoperative nursing workload in colorectal surgery. A prospective study was used to assess footsteps, quality of life, and nursing workload. Number of footsteps was recorded from preoperative day 5 to postoperative day 3. Patients with reduced and good mobilization were compared, and the cut-off defined by the median daily preoperative footsteps. Quality of life was assessed by the Cleveland Global Quality of Life (CGQL). Nursing workload was calculated using the Project Research in Nursing (PRN) score. Statistical correlation was measured by use of the Pearson coefficient. Fifty patients were included. Mean age was 59 years, mean body mass index was 25 kg/m2, and 68% of them were males. Demographics, surgical details, and clinical outcomes were comparable between the group of patients with poor mobilization compared to those with good mobilization. No correlation was found between pre- or post-operative footsteps and CGQL (r = − 0.072, p = 0.640 and r = − 0.127, p = 0.407), as well as between the number of pre- or post-operative footsteps and PRN (r = 0.060, p = 0.687 and r = − 0.095, p = 0531). In conclusion, no correlation was found between the number of perioperative footsteps, quality of life, and nursing workload after colorectal surgery.

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.

Preoperative patients' quality of life and outcomes after colorectal surgery: A prospective study.

The aim of this prospective study was to assess the influence of preoperative life satisfaction on objective and subjective outcomes after elective colorectal surgery. Preoperative life satisfaction was assessed using a validated questionnaire (Échelle de Mesure des Manifestations du Bien-Être Psychologique). Postoperative quality of life was assessed by the Cleveland Global Quality of Life and QLQ-C30. Number of footsteps was recorded from preoperative day 5 to postoperative day 3. Physical activity, length of stay, and complications were compared between patients with low and high preoperative life satisfaction. Fifty patients were included. There was no difference between the 2 groups concerning postoperative objective (length of stay, complications, and number of footsteps) and subjective (Cleveland Global Quality of Life and QLQ-C30) recovery. In conclusion, preoperative life satisfaction of colorectal surgery patients had no influence on outcomes and physical activity in colorectal surgery.

D-pouch: a modified ileal J-pouch for patients with ulcerative colitis and familial adenomatous polyposis.

Ileal J-pouch anal anastomosis (J-IPAA) is the standard approach for patients requiring restorative proctocolectomy due to familial adenomatous polyposis (FAP) or ulcerative colitis (UC). To obviate the risk of a J-tip leak, we modified the J-pouch with a D-pouch anal anastomosis (D-IPAA) designed to eliminate the ileal stump. The aim of our study was to evaluate the feasibility, safety and medium-term functional outcomes of D-IPAA. A retrospective comparison was made between D-IPAA and J-IPAA constructions after a restorative proctocolectomy. Clinical data were collated between October 2014-March 2018 recording operation duration, pouch construction time, pouch volume, intraoperative estimated blood loss, complication rates, readmissions and cumulative length of hospitalization. Continence was assessed at the final visit with the Wexner Cleveland Clinic Score along with the Cleveland Global Quality of Life (CGQL) scale. A total of 97 patients with FAP (n = 28) and UC (n = 69) who had J-IPAA (n = 54) or D-IPAA (n = 43) after proctocolectomy were identified. Patients were well matched with no differences noted in the intraoperative variables between the J- and D-pouch groups. The D-pouch construction time was shorter than that for a standard J-pouch. There was no difference in major or minor complications between groups.Apouchleak developed in each group: a cutaneous fistula from J tip leak in the J-IPAA groupand a pouch-vaginal fistula from the IPAAthe D-IPAA group. Clinical outcomes (the number of bowel movements) were equivalent in the two groups with the Wexner score significantly improving within each group up to 2.5years and with improvement in the CGQL after surgery. The D-pouch construction is safe and feasible for patients with UC and FAP with good functional outcome over the medium term and the potential to reduce the risk of pouchleaks.

Transanal proctocolectomy and ileal pouch-anal anastomosis (TaIPAA) for ulcerative colitis: medium term functional outcomes in a single centre

BackgroundTransanal dissection of the rectum has been recently introduced for ileal pouch-anal anastomosis (IPAA) in UC showing promising results. Thanks to the precise identification of the rectotomy site the risk of long rectal stump is avoided, and a single stapled anastomosis is performed easily. The aim of this study is to analyze our initial experience of transanal proctocolectomy and ileal pouch-anal anastomosis (TaIPAA), considering postoperative complications and medium-term functional outcomes.MethodsOur Center has experienced the transanal approach for proctectomy and IPAA since August 2018. All patients underwent Enhanced Recovery After Surgery (ERAS) protocol. Postoperative complications occurring within 30 days after surgery were taken into consideration. Fecal continence, genito-urinary activity and global quality of life at 1 and 6 months after ileostomy reversal have been assessed.ResultsUntil March 2019, 8 patients underwent transanal proctocolectomy and ileal pouch-anal anastomosis (TaIPAA). In all cases the laparoscopic approach was performed during the transabdominal phase; abdominal drainage was never used. At the time of the pouch construction a defunctioning loop ileostomy was created in all patients. Stoma closure was performed in all cases at a median time of 6 months after surgery. Postoperative complications occurred in only one patient, who showed rectal bleeding, not required a re-invertation. There were no cases of anastomotic leakage. Medium-term functional outcomes were determined prospectively using previously validated quality of life questionnaires (Cleveland Global Quality of Life). Fecal incontinence for liquid or solid stool, genitourinary and sexual functions were also investigated, showing comparable results with the literature data.ConclusionsIn our experience, transanal proctocolectomy and ileal pouch-anal anastomosis provided good short and medium-term functional results in UC.

Surgical results and quality of life of patients submitted to restorative proctocolectomy and ileal pouch-anal anastomosis.

restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the surgical procedure of choice in some cases of familial adenomatous polyposis (FAP) and ulcerative colitis (UC). IPAA allows complete removal of the diseased colon and rectum, however, it is associated with substantial morbidity and potential consequences to patients' quality of life (QoL). to evaluate the surgical results, functional outcomes and QoL after IPAA; and to examine the impact of surgical complications upon QoL. we reviewed the records of 55 patients after IPAA, with emphasis on surgical outcomes. Forty patients answered the questionnaires. The Cleveland Global Quality of Life (CGQL), Inflammatory Bowel Disease Questionnaire (IBDQ), and Short Form 36 Health Survey Questionnaire (SF36). the average age was 42.1±14.1 years. 63.6% of the patients were male, and 69.1% had FAP. Operative mortality was 1.8% and overall morbidity was 76.4%. Anastomotic leakage was the most frequent early complication (34.5%). Pouchitis (10.8%) and small bowel obstruction (9.1%) were the most common late complications. Patients with UC had the most severe complications (p=0.014). Pelvic complications did not have a negative effect on functional outcomes or QoL scores. Female patients had decreased pouch evacuation frequency, fewer nocturnal bowel movements, decreased bowel symptom impact on QoL (p=0.012), and better CGQL (p=0.04). Patients with better education had better QoL scores, and patients who had their pouches for more than five years scored lower. the high morbidity has no impact on function or QoL. Bowel function is generally acceptable. QoL is good and affected by sex, education and time interval since IPAA.

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

Factors Associated with Long-Term Quality of Life After Restorative Proctocolectomy with Ileal Pouch Anal Anastomosis

The aimThe aim of this study was to analyze factors associated with quality of life (QoL) after ileal pouch anal anastomosis (IPAA). MethodsPatients who underwent IPAA (1983–2015) and replied to QoL questionnaire were identified from an IRB-approved prospectively maintained IPAA-database. QoL was assessed using Cleveland Global Quality of Life (CGQL) questionnaire at 1, 3, 5, and 10 years postoperatively. Patient cohort was divided in two groups: overall QoL score ≤ 0.7 (low) and > 0.7 (high). Demographics, perioperative morbidity, and functional results were analyzed. ResultsA total of 4059 patients replied to the questionnaire at the most recent follow-up and were included. A total of 2889 (71%) had overall QoL > 0.7 (group 1) and 1170 (29%) patients had overall QoL ≤ 0.7 (group 2). Patients in group 1 had lower rates of early (44.6 vs. 50.4%, p = 0.003) and late (55.7 vs. 64.5%, p < 0.003) postoperative complications. Kaplan-Meier survival analysis demonstrated significantly higher rates of pouch failure among patients with lower QoL. Pouchitis, obstruction, fistulas, higher number of stools, and IPAA performed during the most recent decade (2005–2015) were significantly associated with lower QoL (≤ 0.7), while S-pouch configuration was associated with higher QoL (> 0.7). ConclusionPatient’s characteristics and minimal perioperative complications impact patient’s QoL following IPAA not only in the short term, but also in the long term.

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.

Long-term outcomes following ileal pouch-anal anastomosis in patients with indeterminate colitis

BackgroundThe advisability of performing ileal pouch–anal anastomosis for patients with indeterminate colitis is debated. Indeterminate colitis is found in up to 15% of inflammatory bowel disease colectomy specimens. We determined long-term outcomes in patients diagnosed with indeterminate colitis undergoing ileal pouch–anal anastomosis. MethodsFifty-six patients were included with a mean follow-up of 14 ± 7 years. Long-term behavior was defined based on surgeon assessment as “Crohn disease–like” in patients who subsequently developed clear signs of Crohn disease and as “non-Crohn disease–like.” Long-term function was assessed using the Cleveland Global Quality of Life and Pouch Functional Score. ResultsThirty-nine percent of patients developed Crohn disease–like behavior, and 61% developed non-Crohn disease–like behavior. Both groups experienced a high rate of pouchitis (57%). Crohn disease–like patients required more anti-inflammatory/immunomodulatory medications (95% vs 18%, P < .001), dilatations for afferent-limb strictures (41% vs 0%, P < .001), and pouch reoperations (32% vs 6%, P = .02). Eight patients required pouch excision or diversion (7 with Crohn disease–like behavior). The Pouch Functional Score was equivalent between groups. ConclusionLong-term function after ileal pouch–anal anastomosis for the majority of indeterminate colitis patients was good. Approximately 40% eventually exhibited Crohn disease–like behavior, but the majority had acceptable function and quality of life. Ileal pouch–anal anastomosis is an appropriate surgical option for indeterminate colitis patients after informed consent.

Quality of life of ulcerative colitis patients treated surgically with proctocolectomy and J-pouch formation: a comparative study before surgery and after closure of the defunctioning ileostomy.

Background:Ulcerative colitis (UC) is a lifelong disease with a relapse-remission pattern that affects patients’ social and psychological wellbeing. Restorative proctocolectomy and J-pouch formation is the gold-standard surgical procedure in cases where symptoms are refractory to currently available medical treatment. The aim of this study was to assess patients’ quality of life (QoL) in order to evaluate the efficiency of surgery and patients’ symptomatology.Methods:We performed a prospective comparative study of the QoL of 47 patients with UC, treated surgically. As research tools, we used the Inflammatory Bowel Disease Questionnaire (IBDQ) and the Cleveland Global Quality of Life (CGQL) questionnaire. Parametric and non-parametric tests were used in order to correlate areas of QoL and other selected factors, such as marital status, sex, age, and education.Results:The mean scores before and after closure of the ileostomy were 153.29 and 178 for the IBDQ (P=0.0025), and 17.4 and 23.42 for the CGQL (P<0.001), suggesting an overall improvement in QoL. The research showed that there was no specific QoL factor, such as intestinal, systemic, emotional or social life symptoms, that improved significantly more than the others (P=0.99). The IBDQ showed that patients aged less than 20 years (P<0.001), female patients (P=0.03) and patients with secondary education (P<0.001) reported the greatest improvement.Conclusions:The QoL in UC patients treated surgically improved following closure of the de-functioning ileostomy. QoL studies are encouraged to optimize and maintain high standards of surgical care, and they could potentially be used for assessment of therapeutic efficacy.

Psychological Factors in Irritable Pouch Syndrome and Other Pouch Disorders.

Restorative proctocolectomy with ileal pouch-anal anastomosis is the surgical treatment of choice for patients with medically refractory ulcerative colitis. Postsurgery, functional and inflammatory complications of the ileal pouch often occur. Our previous study demonstrated that irritable pouch syndrome (IPS) is associated with the use of antidepressants or anxiolytics, suggesting an influence of psychological factors on patients' symptoms. The aim of this study was to identify the specific psychological factors and coping strategies in patients with functional (IPS) and inflammatory (pouchitis, cuffitis, Crohn's disease of the pouch) pouch disorders. Consecutive patients with functional pouch disorders (IPS), inflammatory pouch conditions, and asymptomatic ileal pouch-anal anastomosis patients were surveyed using validated measures of quality of life (the Cleveland Global Quality of Life [CGQL] and Irritable Bowel Syndrome-Quality of Life [IBS-QOL]), daily functional impairment (WSAS), coping mechanisms (brief COPE) and anxiety/depression (DASS-21). Of 243 patients surveyed, 157 (64.6%) completed the surveys, of whom 137 (56.4%) met inclusion criteria and were included in the analysis. Sixty-one percent of respondents had pouch inflammation (pouchitis, N = 35; cuffitis, N = 14; and Crohn's disease of the pouch, N = 35), 20% had IPS (N = 27) and 19% (N = 26) had asymptomatic normal pouches. The age of participants ranged from 20 to 79 years with the mean ages of patients with normal pouches, IPS and inflammatory pouch conditions being 51.7 ± 12.5, 47.1 ± 15.0, 47.2 ± 15.1 years, respectively. Patients with IPS were more likely to be taking antidepressants, anxiolytics, or narcotics than the other groups (P < 0.04). Patients with IPS or inflammatory pouches had significantly poorer quality of life (CGQL, P < 0.001; IBS-QOL, P < 0.003) than those with asymptomatic pouches, with differences particularly in the areas of food avoidance, activity interference, and sexual difficulties. Those with IPS (median = 11; interquartile range [IQR]: 3-19) or inflammatory pouch conditions (median = 7; IQR: 3-18) had a greater impairment in the domains of daily functioning related to the pouch condition than those with normal pouches (median = 1.5; IQR: 0-6; P = 0.003). The mean depression symptom scores were significantly higher in the IPS group than in the normal pouch group (11.7 ± 9.7 versus 4.4 ± 6.2; P = 0.012). IPS patients were more likely to have depressive symptoms and had a greater amount of impairment in daily functioning related to their pouch condition. Additionally, patients with functional pouch disorders are more likely to be concurrently treated with antidepressants, anxiolytic or narcotic agents than those with inflammatory pouches or normal pouches.

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.