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Health related quality of life in Crohn's proctocolitis does not differ from a general population when in remission
Linköpings universitet, Institutionen för biomedicin och kirurgi, Kirurgi. Linköpings universitet, Hälsouniversitetet.
Linköpings universitet, Institutionen för biomedicin och kirurgi, Kirurgi. Linköpings universitet, Hälsouniversitetet.
Linköpings universitet, Hälsouniversitetet.
Linköpings universitet, Institutionen för biomedicin och kirurgi, Kirurgi. Linköpings universitet, Hälsouniversitetet.
Vise andre og tillknytning
2003 (engelsk)Inngår i: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 5, nr 1, s. 56-62Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Objective  All treatment in Crohn's disease, although palliative, aims at restoring full health. The objective of this study was to compare health-related quality of life and psychosocial conditions in patients with Crohn's proctocolitis with a general population.

Patients and methods  One hundred and twenty-seven patients with Crohn's proctocolitis (median age 44 years, 44.1% men) were compared with 266 controls (median age 45 years, 50.7% men). A questionnaire consisting of the Short Form-36 (SF-36), the Psychological General Well-Being Index (PGWB) and a visual analogue scale (VAS) evaluating general health as well as questions regarding psychosocial conditions was used. Disease activity was evaluated by Best's modification of the classical Crohn's Disease Activity Index.

Results  Patients in remission had a health related quality of life similar to controls according to the SF-36 apart from general health where scores were lower (P < 0.01). Patients with active disease scored lower in all aspects of the SF-36 (P < 0.001 or P < 0.0001) as well as the PGWB (P < 0.0001). In a model for multiple regression including age, gender, concomitant small bowel disease, permanent stoma, previous colonic surgery, disease activity, duration, and aggressiveness, disease activity was the only variable negatively predicting all 8 domains of the SF-36 in the patient group (P < 0.001). The mean annual sick-leave for patients and controls were 33.9 and 9.5 days (P < 0.0001), respectively. Sixty-eight percent of the patients and 78.4% of the controls (P = 0.04) were married or cohabited, 67.7% and 78.0% (P = 0.04), respectively, had children.

Conclusion  The health related quality of life for patients with Crohn's proctocolitis in remission does not differ from the general population. The disease has, however, a negative impact on parenthood, family life and professional performance.

sted, utgiver, år, opplag, sider
2003. Vol. 5, nr 1, s. 56-62
HSV kategori
Identifikatorer
URN: urn:nbn:se:liu:diva-24877DOI: 10.1046/j.1463-1318.2003.00407.xLokal ID: 9279OAI: oai:DiVA.org:liu-24877DiVA, id: diva2:245200
Tilgjengelig fra: 2009-10-07 Laget: 2009-10-07 Sist oppdatert: 2017-12-13bibliografisk kontrollert
Inngår i avhandling
1. Surgery and anorectal function in Crohn's colitis
Åpne denne publikasjonen i ny fane eller vindu >>Surgery and anorectal function in Crohn's colitis
2003 (engelsk)Doktoravhandling, med artikler (Annet vitenskapelig)
Abstract [en]

The study concerns surgery in Crohn's disease, particularly Crohn's colitis, its relation to medical treatment, symptomatic load, perceived health, quality of life, outcome on anorectal function and also anorectal physiologic conditions.

Four hundred and thirty-two patients treated at the University Hospital, Linköping from 1970 to 1997 were included in the study. Operations and medical treatment were retrospectively reviewed, whereas symptomatic load, perceived health, quality of life, function outcome and anorectal physiology were prospectively evaluated.

In a cross-sectional analysis of all patients surveilled 1995 the annual incidence of surgery was 5.7% in a population-based cohort and 10.3% in referred patients. Medical maintenance treatment was used in 61 and 55% respectively. This led to 89% of the patients being in clinical remission or having only mild symptoms and to a large proportion with a perception of good health. The treatment was paralleled by a low rate of septic and surgical complications.

Surgical treatment of Crohn's colitis prior to 1990 mainly implied colectomy or proctocolectomy and thereafter almost exclusively segmental resection. The creation of a permanent stoma decreased and was rarely needed at the end of the study period when the annual risk was 0.23%. This development was basically due to a deliberate change in surgical attitude aiming at introducing similar treatment principles as for small bowel Crohn's disease With limited resections and preservation of transanal defecation. The reduced colectomy rate may have been facilitated by the introduction of immunosuppressive medical treatment as a reduction of colectomies tended to be associated with medical maintenance treatment during the later part of the study. Time from diagnosis to surgery was prolonged and stricture replaced active disease as the major indication for surgery. Symptomatic load and anorectal function outcome were better after segmental resection without the expense of an increased reresection rate. Seventy percent of patients with Crohn's colitis were in clinical remission and these patients scored quality of life similar to the general population but patients with active disease scored worse in all indexed aspects. The need of immunosuppression or previous surgery was not related to quality of life except when operated with a permanent stoma which negatively influenced psychological well being.

Anorectal physiology in Crohn's disease differed from controls with increased anal resting pressures and increased rectal sensitivity. This provides possible prerequisites for later development of anal pathology such as fissures and fistulas.

The study indicates that the concept oflimited surgery is applicable also in Crohn's colitis with obvious benefits for the patients. A treatment concept including medical maintenance treatment and limited resections implies that the vast majority of patients with Crohn's disease may live with only minor symptoms and minimal risk of having a permanent stoma, factors associated with a quality of life similar to that of the general population.

sted, utgiver, år, opplag, sider
Linköping: Linköpings universitet, 2003. s. 47
Serie
Linköping University Medical Dissertations, ISSN 0345-0082 ; 769
HSV kategori
Identifikatorer
urn:nbn:se:liu:diva-25547 (URN)9994 (Lokal ID)91-7373-526-4 (ISBN)9994 (Arkivnummer)9994 (OAI)
Disputas
2003-01-24, Berzeliussalen, Hälsouniversitetet, Linköping, 09:00 (svensk)
Opponent
Tilgjengelig fra: 2009-10-07 Laget: 2009-10-07 Sist oppdatert: 2012-09-25bibliografisk kontrollert

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