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Effect of intestinal resection on quality of life in Crohn's disease
Wright, Emily K. Kamm, Michael A. De Cruz, Peter Hamilton, Amy L. Ritchie, Kathryn J. Krejany, Efrosinia O. Gorelik, Alexandra Liew, Danny Prideaux, Lani Lawrance, Ian C.
Wright, Emily K.
Kamm, Michael A.
De Cruz, Peter
Hamilton, Amy L.
Ritchie, Kathryn J.
Krejany, Efrosinia O.
Gorelik, Alexandra
Liew, Danny
Prideaux, Lani
Lawrance, Ian C.
Author
Wright, Emily K.
Kamm, Michael A.
De Cruz, Peter
Hamilton, Amy L.
Ritchie, Kathryn J.
Krejany, Efrosinia O.
Gorelik, Alexandra
Liew, Danny
Prideaux, Lani
Lawrance, Ian C.
Andrews, Jane M.
Bampton, Peter A.
Sparrow, Miles P.
Florin, Timothy H.
Gibson, Peter R.
Debinski, Henry
Gearry, Richard B.
Macrae, Finlay A.
Leong, Rupert W.
Kronborg, Ian
Radford-Smith, Graham
Selby, Warwick
Johnston, Michael J.
Woods, Rodney
Elliott, P. Ross
Bell, Sally J.
Brown, Steven J.
Connell, William R.
Desmond, Paul V.
Kamm, Michael A.
De Cruz, Peter
Hamilton, Amy L.
Ritchie, Kathryn J.
Krejany, Efrosinia O.
Gorelik, Alexandra
Liew, Danny
Prideaux, Lani
Lawrance, Ian C.
Andrews, Jane M.
Bampton, Peter A.
Sparrow, Miles P.
Florin, Timothy H.
Gibson, Peter R.
Debinski, Henry
Gearry, Richard B.
Macrae, Finlay A.
Leong, Rupert W.
Kronborg, Ian
Radford-Smith, Graham
Selby, Warwick
Johnston, Michael J.
Woods, Rodney
Elliott, P. Ross
Bell, Sally J.
Brown, Steven J.
Connell, William R.
Desmond, Paul V.
Abstract
Introduction: Patients with Crohn’s disease have poorer health-related quality of life [HRQoL] than healthy individuals, even when in remission. Although HRQoL improves in patients who achieve drug-induced or surgically induced remission, the effects of surgery overall have not been well characterised. Methods: In a randomised trial, patients undergoing intestinal resection of all macroscopically diseased bowel were treated with postoperative drug therapy to prevent disease recurrence. All patients were followed prospectively for 18 months. C-reactive protein [CRP], Crohn’s Disease Activity Index [CDAI], and faecal calprotectin [FC] were measured preoperatively and at 6, 12, and 18 months. HRQoL was assessed with a general [SF36] and disease-specific [IBDQ] questionnaires at the same time points. Results: A total of 174 patients were included. HRQoL was poor preoperatively but improved significantly [p < 0.001] at 6 months postoperatively. This improvement was sustained at 18 months. Females and smokers had a poorer HRQoL when compared with males and non-smokers, respectively. Persistent endoscopic remission, intensification of drug treatment at 6 months, and anti-tumour necrosis factor therapy were not associated with HRQoL outcomes different from those when these factors were not present. There was a significant inverse correlation between CDAI, [but not endoscopic recurrence, CRP, or FC] on HRQoL. Conclusion: Intestinal resection of all macroscopic Crohn’s disease in patients treated with postoperative prophylactic drug therapy is associated with significant and sustained improvement in HRQoL irrespective of type of drug treatment or endoscopic recurrence. HRQoL is lower in female patients and smokers. A higher CDAI, but not direct measures of active disease or type of drug therapy, is associated with a lower HRQoL.
Keywords
Crohn’s disease, inflammatory bowel disease, postoperative, health-related quality of life, biologicals, smoking
Date
2015
Type
Journal article
Journal
Journal of Crohn's and Colitis
Book
Volume
9
Issue
6
Page Range
452-462
Article Number
ACU Department
Relation URI
Source URL
Event URL
Open Access Status
License
File Access
Controlled