Effect of intestinal resection on quality of life in Crohn's disease
| Autor: | Rupert W. Leong, Miles P. Sparrow, Amy L. Hamilton, Lani Prideaux, Kathryn J. Ritchie, William Connell, Peter De Cruz, H.S. Debinski, Danny Liew, Emily K Wright, Richard B. Gearry, Rodney Woods, P. Ross Elliott, Peter R. Gibson, Graeme Radford-Smith, Sally Bell, Jane M. Andrews, Steven J. Brown, Ian C. Lawrance, Alexandra Gorelik, Michael J. Johnston, Paul V. Desmond, Efrosinia O. Krejany, Ian Kronborg, Michael A. Kamm, Timothy H. Florin, Warwick Selby, Finlay A. Macrae, Peter A. Bampton |
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| Jazyk: | angličtina |
| Rok vydání: | 2015 |
| Předmět: |
Male
Crohn’s disease Time Factors medicine.medical_treatment Anti-Inflammatory Agents Inflammatory bowel disease Gastroenterology Severity of Illness Index Feces Quality of life Maintenance therapy Crohn Disease Recurrence Surveys and Questionnaires postoperative Prospective Studies Prospective cohort study Cecum Colectomy Crohn's disease Remission Induction General Medicine Bowel resection Colonoscopy Middle Aged humanities health-related quality of life C-Reactive Protein biologicals Female Immunosuppressive Agents Adult medicine.medical_specialty smoking Young Adult Sex Factors Ileum inflammatory bowel disease Internal medicine medicine Humans Watchful Waiting business.industry Adalimumab medicine.disease Crohn's Disease Activity Index Faecal calprotectin Surgery Quality of Life business Leukocyte L1 Antigen Complex Follow-Up Studies |
| Popis: | 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. Copyright |
| Databáze: | OpenAIRE |
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