Health-related Quality Of Life In Inflammatory Bowel Disease Patients Research Articles

Trends and Factors Related to Quality of Life in Patients with Inflammatory Bowel Disease.

Inflammatory bowel disease (IBD) affects health-related quality of life (HRQoL). The Short Inflammatory Bowel Disease Questionnaire (SIBDQ) score is strongly correlated with HRQoL in IBD patients. This study aimed to assess the factors influencing HRQoL in IBD patients. In this prospective study, all patients with ulcerative colitis (UC) and Crohn's disease (CD) completed the SIBDQ at enrollment; some patients also completed a second SIBDQ at follow-up. Multiple linear regression analysis was used to determine associations between SIBDQ scores and clinical factors. A total of 1,020 patients participated (UC, 67%; CD, 33%). The median SIBDQ score was 52 (interquartile range, 44 to 59). In UC patients, the stool frequency (β=-2.333, p<0.001), Physician Global Assessment score (β=-3.950, p<0.001), fecal calprotectin level (β=-4.014, p<0.001), and corticosteroid use (β=-4.809, p=0.006) were negatively correlated with the SIBDQ score. In CD patients, the number of diarrhea episodes per day (β=-1.467, p=0.024) and Crohn's Disease Activity Index score (β=-0.045, p<0.001) were negatively correlated with the SIBDQ score. A total of 202 patients completed the second SIBDQ within a mean of 3.4 years. The distributions of SIBDQ score changes were as follows: decrease >10%, 28%; -10%<change<10%, 29%; and increase >10%, 43%. In both the initial SIBDQ and follow-up SIBDQ, scores for items pertaining to systemic symptoms (tension and fatigue) were relatively low. Bowel movement-related problems significantly affect the HRQoL of both UC and CD patients. IBD patients scored lower on SIBDQ items related to general well-being. After 3 years of follow-up at the IBD clinic, 43% of patients showed a significant improvement in HRQoL.

Impact of the Coronavirus Disease Pandemic on Health-Related Quality of Life of Patients with Inflammatory Bowel Disease

BackgroundTo learn from the crisis caused by the coronavirus disease (COVID-19) pandemic and be prepared for future pandemics, it is important to investigate the impact of this period on the wellbeing of patients with inflammatory bowel disease (IBD).AimsTo describe the health-related quality of life (HRQoL) and disease control of IBD patients during the first wave of the COVID-19 pandemic in The Netherlands.MethodsBetween March 17 and July 1, 2020, patients aged 18 years and older with IBD from the Erasmus MC (Rotterdam, The Netherlands) were invited to complete online questionnaires at week 0, 2, 6 and 12. The Inflammatory Bowel Disease Questionnaire (IBDQ), the Inflammatory Bowel Disease Control-8 (IBD-control-8) and the numeric rating scale on fatigue were used. The evolution of the different outcomes over time was measured using mixed models.ResultsOf 1151 invited patients, 851 patients (67% CD and 33% UC or IBD-U) participated in the study (response rate 74%). No relevant changes in total scores were found over time for the IBDQ (effect estimate 0.006, 95% CI [− 0.003 to 0.015]) and IBD-control-8 (effect estimate 0.004, 95% CI [0.998–1.011]). There was a slight, increasing trend in fatigue scores over time (effect estimate 0.011, 95% CI [0.004, 0.019]).ConclusionsThis first lock down due to the COVID-19 pandemic in The Netherlands did not impact on the HRQoL and disease control of patients with IBD. Up to date information may have contributed to a stable HRQoL in IBD patients even in an extreme period with restrictions and insecurities.

P163 The impact of the COVID-19 pandemic on Health-Related Quality of Life of Patients with Inflammatory Bowel Disease in The Netherlands

BackgroundTo learn from the current crisis caused by the COVID-19 pandemic and be prepared for future pandemics, it is important to investigate the impact of this extraordinary period on the wellbeing of patients with inflammatory bowel disease (IBD). Therefore, the aim of this research was to describe the self-reported Health-Related Quality of Life (HRQoL) and disease control of patients with IBD from the start of the COVID-19 pandemic and measures in The Netherlands.MethodsThis was a prospective study initiated on March 17, 2020 until July 1st, 2020. All patients aged 18 years and older with IBD that visited the Erasmus MC (Rotterdam, The Netherlands) outpatient clinic between March 2019 to February 2020 received up to date information on COVID-19. Patients were invited to complete online questionnaires at week 0, 2, 6 and 12. The Inflammatory Bowel Disease Questionnaire (IBDQ), the Inflammatory Bowel Disease control-8 (IBD-control-8 and the Numeric Rating Scale (NRS) on fatigue were used. The evolution of the different outcomes over time was measured using mixed models.ResultsOf 1151 invited patients, 851 participants (67% had CD and 33% UC or IBD-U) completed one or more questionnaires (response rate 74%). Median age of the participants was 41 years, with 57% being female. No relevant changes in total scores were found over time for the IBDQ (effect estimate 0.006, 95% CI [-0.003–0.015]) and IBD-control-8 (effect estimate 0.004, 95% CI [0.998–1.011]). There was a slight, increasing trend in fatigue scores over time (effect estimate 0.011, 95% CI [0.004, 0.019]).ConclusionThis first lock down due to the COVID-19 pandemic in The Netherlands did not impact on the HRQoL and disease control of patients with IBD. Up to date information may have contributed to a stable HRQoL in IBD patients even in an extreme period with restrictions and insecurities.

Disability and quality of life before and during the COVID-19 outbreak: A cross-sectional study in inflammatory bowel disease patients.

Background/Aim:Inflammatory bowel disease (IBD) is a chronic disorder affecting patients' health-related quality of life (HRQoL) which adds to their disability. Little is known about the impact of the COVID-19 pandemic on HRQoL of IBD patients. We aimed to evaluate HRQoL in IBD patient's pre- and post-COVID-19 pandemic using the IBD-disk questionnaire and explore associations between socio demographic factors, disease types, severity and impaired HRQoL in patients with IBD.Patients and Methods:A cross-sectional study was conducted at a tertiary care centre in Saudi Arabia between November 2019 and March 2020 at the outpatient IBD clinics. The HRQoL of patients was assessed using the 10-item IBD-disk questionnaire.Results:A total of 59 IBD patients (40 Crohn's disease, 19 Ulcerative colitis) with a mean disease duration of 3.5 years were included. Most of the patients (77.97%) were on biologics while 35.59% were on immune modulators, 16.94% on 5-ASA, and 3.38% were on corticosteroids. There was no difference between any of the 10 IBD-disk variables pre and post-COVID-19 pandemic apart from the perception of body image, where there was a slightly more negative perception with an increase from 2.53 to 3.39 (P = 0.05) There was no significant difference in HRQoL between patients with ulcerative colitis and Crohn's disease in any of domains.Conclusion:The current study showed that disability and HRQoL appears to be unaffected by the COVID-19 pandemic among our cohort, however further studies with longer follow up and larger sample size is needed.

Assessment of Quality of Life in Chinese Patients With Inflammatory Bowel Disease and their Caregivers.

Chronic diseases such as inflammatory bowel disease (IBD) usually affect the psychological status and health-related quality of life (HRQOL) of patients and their caregivers. The aim of this study was to evaluate the level of anxiety, depression, and HRQOL and find the risk factors predictive of HRQOL in IBD patients and their caregivers in a Chinese population. One hundred four adult patients with IBD, 102 family caregivers, and 99 healthy controls were enrolled. They completed self-administered surveys related to QOL and psychological questionnaires, including the Short Inflammatory Bowel Disease Questionnaire (patients only), the Short Form-36 Health Survey (SF-36), Self-rating Anxiety Scale (SAS), and Self-rating Depression Scale (SDS). Both the mean SAS total score and the mean SDS total score among the patients and the caregivers were found to be significantly higher than those among the general population (P < 0.05). Total SF-36 score was significantly different between the patients and the general population (P = 0.001), and between caregivers and the general population (P = 0.011). The result showed that the total SF-36 score of the patients had a significant negative correlation with SAS score in the patients (P = 0.040), SDS score in the patients (P = 0.004), annual income (P = 0.036), use of biologicals (P = 0.028), frequency of hospitalization in the last year (P = 0.033), and severity of IBD (P = 0.021). The total SF-36 score of the caregivers was significantly and negatively correlated with SDS score in the caregivers (P = 0.010), SDS score in the patients (P = 0.010), use of biologicals (P = 0.013), and frequency of hospitalization in the last year (P = 0.010) of the patients. A large proportion of IBD patients and their caregivers experience a high level of anxiety and depression and an impaired HRQOL. Higher levels of anxiety and depression, annual income, use of biologicals, higher frequency of hospitalization in the last year, and disease activity were independent predictors of reduced patient HRQOL; higher levels of depression in both caregivers and patients, use of biologicals, and frequency of hospitalization in the last year of the patients were independent predictors of reduced caregiver HRQOL.

Medication use among inflammatory bowel disease patients: excessive consumption of antidepressants and analgesics

Objective. Little is known about differences in the use of medications between inflammatory bowel disease (IBD) patients and the general population. The aims of this study were to observe those differences and to discuss reasons for them. The relation between medication use and HRQoL of IBD patients was examined. Material and methods. The use of prescribed medication of 2831 IBD patients and 5662 control subjects were scrutinized and compared by utilizing a national reimbursement register. Annual costs and number of defined daily doses (DDD) of medications were calculated. The relationship between medications and health-related quality of life (HRQoL) of IBD patients was examined by using a postal questionnaire including a generic (15D) and a disease-specific (IBDQ) HRQoL tool. The questionnaire also included demographic questions and questions about IBD patients' use of biological medications. Results. Use of antidepressants (OR: 1.44, 95% CI: 1.28–1.61), anxiolytics (OR: 1.52, 95% CI: 1.31–1.78), oral bisphosphonates (OR: 6.08, 95% CI: 4.56–8.11), cardiovascular medications (OR: 1.38, 95% CI: 1.24–1.54), antibiotics (OR: 4.01, 95% CI: 3.57–4.51), proton pump inhibitors (OR: 3.90, 95% CI: 3.48–4.36), and nonsteroidal anti-inflammatory analgesics (OR: 1.17, 95% CI: 1.07–1.28) was significantly more common in IBD than among the controls. Those who used antidepressants, anxiolytics, or analgesics had significantly impaired HRQoL (p < 0.001). Conclusions. IBD patients and general population differ in terms of their medicine use in many respects, and especially use of analgesics and antidepressants is more common among IBD patients. Use of antidepressants, anxiolytics, and analgesics was related to impaired HRQoL.

P085 Primary sclerosing cholangitis in the course of inflammatory bowel disease in children

available data suggests that alexithymia could be highly prevalent and independent from disease activity in patients with inflammatory bowel disease (IBD) and it could affect disease management and symptom perception, which may in turn have an impact on health-related quality of life (HRQOL). The aim of this study was to assess the influence of alexithymia on HRQOL in IBD patients. Methods: A cross-sectional, prospective study with consecutive patient recruitment was designed. The case-studies consisted of consecutive patients with IBD (Crohn’s disease (CD) and ulcerative colitis (UC)) who attended the monographic IBD Unit at the University Hospital of Santiago de Compostela, Spain, from January 2009 to June 2010. To assess quality of life we used The Inflammatory Bowel Disease Questionnaire (IBDQ), which is an instrument specifically designed to assess HRQOL in patients with UC and CD. This is a self-administered questionnaire consisting of 36 items, distributed into five dimensions (Bowel Symptoms, Systemic Symptoms, Functional Impairment, Social Impairment, and Emotional Function), which are scored from 1 to 7 in the Likert scale (corresponding to the worst and best functioning levels respectively). Total scores range from 36 to 252, with higher scores reflecting a better HRQOL. Alexithymia was assessed using the Toronto Alexithymia Scale (TAS-26). This consists of 26 items which are scored from 1 to 5 in the Likert scale. Total scores range from 26 to 130. A cut-off point of 74 is used to identify a subject as alexithymic. Multivariate logistic regression was also used to estimate the factors associated with lower than normal values in the IBDQ. Results: 484 patients agreed to participate and were consecutively recruited; 192 patients (39.7%) had CD, and 292 (60.3%) had UC. The percentage of alexithymic patients was 30.2% (95% CI: 26.0 35.0) of the total sample with no differences in terms of clinical activity or type of disease. Multivariate logistic regression analysis showed that alexithymia (OR = 3.34, 95% CI: 1.98 5.65), depressive symptoms (OR = 3.65, 95% CI: 1.89 7.08), and presence of a psychiatric disorder (OR = 2.3, 95% CI: 1.27 4.20) were risk factors for poor quality of life. Conclusions: This study shows a high prevalence of alexithymia in IBD. In addition, alexithymia is a significant predictor of HRQOL in patients with IBD.

The evaluation of health-related quality of life in patients with inflammatory bowel disease

Objective To investigate the health-related quality of life (HRQoL) and its influencing factors in patients with inflammatory bowel disease (IBD).Methods The IBD patients underwent cross-sectional survey through Chinese version of inflammatory bowel disease questionnaire (C-IBDQ),the HRQoL of IBD patients were evaluated and analyzed with correlation analysis and multiple-linear regression analysis.Results A total of 100 IBD patients finished the questionnaire (UC 80,CD 17,ID 3).The overall score of HRQoL in IBD patients were (175.9±37.9),score of each item decreased,especially in the aspect of emotional function. There was no significantly difference in total scores of HRQoL between UC patients and DC patients (P＞0.05).The HRQoL total scores and each item score of patients in active period were significantly lower than those in remission period (149.4 ± 35.2,195.1 ± 26.7 ; P＜0.05).The HRQoL scores of patients with the duration less than one year were significantly lower than those over one year (P＜0.05).The HRQoL scores of severe patients were significantly lower than those of mild patients (P＜0.05).The HRQoL scores of patients whose medical cost mainly paid by themselves were lower than those paid by medical insurance,there were significant differences in social function and economic burden between these two groups.Multiple linear regressions analysis indicated that the influential factors of HRQoL were disease severity and activity,duration,and the payment.Conclusions The HRQoL of IBD patients are impaired in varying degrees.The influential factors of HRQoL were disease severity and activity,duration,and the payment.The HRQoL of IBD patients is obviously affected by economic burden. Key words: Inflammatory bowel diseases; Quality of life; Fees, medical

Health-related quality of life in inflammatory bowel disease measured with the generic 15D instrument

In many surveys, inflammatory bowel disease (IBD) has been shown to have a negative impact on health-related quality of life (HRQoL), especially when the disease is active. The purpose of this study was to compare a disease-specific HRQoL tool (Inflammatory Bowel Disease Questionnaire, IBDQ) and a generic HRQoL tool (15D) in a large cohort of IBD patients, to assess the ability of the 15D to detect differences in HRQoL between disease states and to compare the HRQoL of IBD patients with that of the general population. The study population comprised 2,931 IBD patients over 18 picked from a national Social Insurance Institute register and from a patient organization register. The 15D data for the general population came from the National Health 2000 Health Examination Survey. For patients with IBD, the 15D tool was feasible and had good discriminatory power. The total 15D score was significantly higher among patients with less active disease estimated by frequency of IBD symptoms and was strongly correlated with total IBDQ score. The general population scored significantly higher than did the study subjects on most of the 15D dimensions. The 15D was a fast and easy-to-apply method for the examination of HRQoL in IBD patients. In addition to HRQoL studies it could be used in everyday practice as well. Patients with IBD have worse HRQoL than do gender- and age-standardized controls.

The effects of thiopurine therapy on health-related quality of life in Inflammatory Bowel Disease patients

BackgroundThe effect of thiopurine immunomodulators on health-related quality of life (HRQoL) in patients with inflammatory bowel disease (IBD) has been controversial. The aims were to evaluate the HRQoL in patients with IBD treated with thiopurines and assess the short- and long-term impacts of the treatment on HRQoL.MethodsNinety-two consecutive patients who started treatment with thiopurines were prospectively included. Evaluation of HRQoL was performed at months 0, 6, and 12 using two questionnaires, the Short-Form Health Survey (SF-36) and the Inflammatory Bowel Disease Questionnaire (IBDQ).ResultsBaseline score of IBDQ was 4,6, range (2,31-6,84), with an impairment of the five dimensions of HRQoL compared with inactive patients. Results obtained in 8 dimensions of SF-36 showed worse HRQoL than Spanish general population. At 6 months patients had a significant improvement in overall IBDQ score -5,8 (1,58 -6,97)- and also in all IBDQ dimensions. All the 8 dimensions of SF-36 obtained a significant improvement. At twelve months score of IBDQ was 6,1, range (2,7-6,98), with improvement in all dimensions compared with baseline and 6 months. SF-36 showed a similar significant improvement in all subscales.ConclusionsThiopurine immunomodulators alone or with other treatments have a positive and long lasting impact on HRQoL of IBD patients.

Psychological Distress, Somatization, and Defense Mechanisms Associated with Quality of Life in Inflammatory Bowel Disease Patients

Clinical parameters predict health-related quality of life (HRQOL) in inflammatory bowel disease (IBD), but some patients have impaired HRQOL despite being in clinical remission. To identify personality and psychological distress variables associated with HRQOL in IBD. In a cross-sectional study of 185 IBD patients, the General Health Questionnaire, the Hopkins' Symptoms Distress Checklist, the Defense Style Questionnaire and the Life Style Index were administered. The Inflammatory Bowel Disease Questionnaire was used for the assessment of HRQOL. Psychological distress was associated with impaired HRQOL in a dose-response fashion. Somatization mediated the relationships of anxiety and depression with HRQOL. Few years of education, more extensive use of the reaction-formation defense mechanism and higher rates of somatization were the variables most closely and independently associated with impaired HRQOL. Somatization and reaction-formation are independent correlates of disease-specific HRQOL in IBD patients, and this could be relevant to psychological interventions.

Factors affecting health related quality of life of patients with inflammatory bowel disease.

Using a disease specific instrument to measure the health related quality of life (HRQOL) of patients with inflammatory bowel disease (IBD), it has been shown that their perceived HRQOL worsens during active disease. The precise factors involved in HRQOL changes reported by these patients are largely unknown. Our aim was to elucidate which socio-demographic and health status variables are related with HRQOL in IBD patients. To this end, 354 patients with IBD were interviewed. To quantify the impairment in the HRQOL, the 36-item version of the inflammatory bowel disease questionnaire (IBDQ) was administered to all patients. To explore the relation of each individual variable on the HRQOL an univariate analysis by using the Spearman correlation, the Mann-Whitney or the Kruskal-Wallis test was performed when necessary. Factors significant at the univariate analysis were assessed using multiple linear regression modeling with global IBDQ score as the dependent factor. Disease type did not predict IBDQ score in the univariate nor in the multivariate analysis. Consequently, statistical analysis was performed in the global group of 354 patients independently of the type of disease. Lower recurrence/year index, longer disease duration, higher level of education, symptom activity, male gender and non-necessity of hospitalization all predict a better HRQOL (p < 0.05). Factors which remained significant (p < 0.05) in the multiple regression modeling were gender, need of hospitalization, symptomatic activity, recurrence/year index and education level. Symptomatic activity and socio-demographic variables such as gender and education are the most important factors involved in the impairment of HRQOL in patients with IBD.