- Email: [email protected]
M1048 Dynamic Improvements of Health-Related Quality After Bariatric Surgery: A One Year Follow-up
M1044
differ significantly between PSC patients and controls (16% vs 21%, p>0.05). According to CLDQ, 15% of patients had significant pruritus, 11% fatigue, 11% body pain and 10% mouth dryness. Patients with compared to those without significant fatigue on CLDQ had lower scores in all SF-36 domains (p<0.05 for all) as well as lower SF-36 physical (32.9 (14.2) vs 48.9 (9.5), p<0.05) and mental (32.2 (16.5) vs 46.9 (10.4), p<0.05) component summaries. The prevalence of significant fatigue did not differ between transplanted patients and the rest of the cohort (10% vs. 11%, p<0.05). In logistic regression analysis significant fatigue was independently related only to psychosocial (Odds ratio (OR) 1.05, p<0.05) but not to physical or cognitive fatigue scores. In multivariate analysis worse fatigue scores on CLDQ were independently related to higher depression scores (OR -0.17) as well as worse body pain (OR 0.2), mouth dryness (OR 0.15), and shortness of breath (OR 0.16, p<0.05 for all) on CLDQ. Small-duct PSC, the Mayo PSC risk score or IBD were not related to fatigue. Conclusion Fatigue seems to be of concern in a subgroup of PSC patients and it is associated with impaired QoL. Non life-threatening symptoms such as psychological distress and body pain rather than associated IBD or PSC severity seem to be major determinants of fatigue.
AGA Abstracts
Appropriate Indication for Upper Endoscopy Based on ASGE Guidelines and Its Relation With Positive Findings Horacio W. Rubio, Teresa Barcia, Horacio W. Rubio, María Cristina Martinez Bottani, Adriana M. Cea INTRODUCTION:Upper gastrointestinal endoscopy (UGE) is a safe and effective diagnostic procedure, but it is relatively costly and implies certain risk.Several guidelines have been published for its appropriate use ,as the American Society for Gastrointestinal Endoscopy (ASGE). AIMS:To assess if UGE is used appropriately according to ASGE guidelines.To assess the probability of detecting significant lesions by endoscopy in patients with appropriate indication and compared it with the endoscopic findings in patients with inappropriate indication.To assess the appropriateness of the indication according to the specialty of the referring physicians. MATERIALS AND METHODS:We included data from 541 consecutive diagnostic UGE from January 2006 to December 2008 in outpatients referred to our center.We recorded age, sex,diagnosis,endoscopic findings and the specialty of the referring physicians. Endoscopic findings that had direct therapeutic or prognostic consequence were classified as “positive” or as “negative”.Indications were classified as appropriate,inappropriate and doubtful according to ASGE guidelines.For statistical analysis we used X 2 test and multiple logistic regression with a confidence level of 95%. RESULTS:We reviewed UGE reports of 364 (67%) women and177 (33%) men.The mean age was 59.91 ± 16 years (range: 17-98). Patients referred by gastroenterologist were 350(65%),179 (33%) by generalists, 7(1%) by surgeons, and by others 5(1% ).The most frequent referrals were upper abdominal pain in 195 (36%) patients, heartburn in 131(24%),iron deficiency anemia in 27( 5%),dyspepsia in 13 (2%) and others in 175 (32%).Indications were classified as appropriate in 330 (61%) cases,inappropriate in 133 (25%) and doubtful in 78 (14%). Positive endoscopic findings were reported in 288 (53%) patients, in 182(55%) with appropriate indication, in 64(48%) with inappropriate indication and 42(54%) in doubtful (p = 0, 38).The clinicians referrals showed the highest percentage of positive endoscopic findings. CONCLUSIONS:This study showed a significant frequency of inappropriate indications for UGE according to ASGE guidelines. The presence of positive endoscopic findings was not related to the appropriateness of the indication, but to the speciality of the referring physicians . This study showed that current guidelines regarding the appropriateneness of UGE are relatively inefficient in excluiding significant endoscopic findings
M1047 Quality-of-Life Benefits for Adalimumab-Treated Patients With Moderate to Severe Crohn's Disease are Predicted by Early Mucosal Healing Status Paul J. Rutgeerts, Roopal Thakkar, Eric Q. Wu, Anna Kaltenboeck, Mei Yang, Parvez Mulani, Jingdong Chao INTRODUCTION: Using data from EXTend the Safety and Efficacy of Adalimumab Through ENDoscopic Healing (EXTEND), we evaluated whether early mucosal healing status predicts long-term quality-of-life (QOL) outcomes for patients with moderate to severe Crohn's disease (CD). METHODS: EXTEND was a randomized, placebo-controlled study of patients with moderate to severe ileocolonic CD (Crohn's Disease Activity Index 220-450). All patients received open-label adalimumab 160-/80-mg induction therapy at Weeks 0/2 and were randomized at Week 4 to maintenance therapy with adalimumab 40 mg every other week or placebo. From Week 8, patients with flares or nonresponse could receive open-label adalimumab. Patients underwent an endoscopic assessment of mucosal activity at baseline, Week 12, and Week 52. In this post-hoc analysis, only patients randomized to adalimumab who had nonmissing endoscopic assessment scores (either consensus score or endoscopists' observation) at Week 12 were included. The associations between QOL outcomes, as measured by the Inflammatory Bowel Disease Questionnaire (IBDQ), at Week 52 and assessments of endoscopic disease activity at Week 12, as measured by the Simple Endoscopic Score for Crohn's Disease (SES-CD) scores, were examined. Data were analyzed using multiple linear regressions, controlling for baseline characteristics such as age, weight, sex, disease duration, and IBDQ score at Week 12. RESULTS: Of the 62 patients included in the analysis, 20 demonstrated mucosal healing and 42 had evidence of mucosal ulceration at Week 12. Multivariate analysis showed significant predictive effects of Week-12 endoscopic assessment scores for Week-52 QOL outcomes. Each 1-point decrease in Week-12 SES-CD score was associated with a 2-point increase in Week-52 IBDQ score (p<0.05). CONCLUSIONS: Mucosal healing status at Week 12 predicted 1-year QOL outcomes, as measured by IBDQ scores, with statistically significant predictive utility for adalimumab-treated patients with CD. With appropriate treatment for CD, early mucosal healing may represent an indicator for sustained long-term improvements in patient QOL.
M1045 Is Sexual Dysfunction in Women After Restorative Proctocolectomy With Ileal Pouch Anal Anastomosis Caused by Autonomic Pelvic Nerve Damage? - A Prospective Clinical Trial Jan Wind, Malaika Vlug, Ellen T. Laan, Rik H. van Lunsen, Paul van Koperen, Sebastiaan W. Polle, Willem Bemelman Introduction Sexual dysfunction after restorative proctocolectomy with ileal pouch anal anastomosis (IPAA) is common. The most systematic physical reaction to sexual stimulation is an increase in vaginal vasocongestion. Genital response can be assessed by vaginal pulse amplitude (VPA) using vaginal photoplethysmography. The objective of the present study was to assess whether restorative proctocolectomy with ileo pouch anal anastomosis is associated with autonomic pelvic nerve damage and changes in subjective indices of sexual function in women. Methods Female patients undergoing IPAA between April 2004 and January 2006 were included. During sexual stimulation (visual and vibrotactile) changes in vaginal vasocongestion were measured by vaginal photoplethysmography. Concurrently, quality of life (SF-36) and sexual functioning (FSFI, FSDS) were assessed using validated questionnaires. Endpoints were difference in VPA, feelings of sexual arousal and estimated lubrication pre- and postoperatively and difference in psychological - and sexual functioning pre - and postoperatively. Results Eleven patients were included. For 8 patients (median age 37 [22-49 yrs]) pre- and post-operative data were collected. VPA analysis showed a significant reduction in vaginal vasocongestion during sexual stimulation post-operatively, P=0.012. Subjective sexual arousal and estimated lubrication during the experiment, reported psychological and sexual functioning pre- and postoperative were not different. Conclusions Vaginal vasocongestion after IPAA was significantly reduced; indicating that IPAA in women may be associated with autonomic pelvic nerve damage or partial devascularisation of the vagina. Subjectively reported sexual arousal, estimated lubrication, psychological and sexual functioning were not diminished. Future research should focus on the possible advantage of a full close rectal dissection in these patients.
M1048 Dynamic Improvements of Health-Related Quality After Bariatric Surgery: A One Year Follow-up Chi-Yang Chang, Chih-Kun Huang, Chi-Ming Tai, Jaw-Town Lin, Jung-Der Wang Objective: The aim of this study was to evaluate the effects of bariatric surgery on the dynamic changes of HRQOL and reduction of co-morbidities along with loss of excess BMI during one year follow-up. Background: Bariatric surgery could reduce body weight and improve health-related quality of life (HRQOL) effectively for subjects with morbid obesity, but no study has shown detailed profiles of HRQOL changes along with time. Methods: Patients were enrolled for bariatric surgery by a modified recommendation of the AsiaPacific consensus. The Taiwan version of WHOQOL-BREF was administered 1 month before the operation, 1, 3, 6, and 12 months after surgery. BMI, co-morbidities and operation related complications were also measured simultaneously. A healthy reference group was randomly sampled from the database of National Health Interview Survey in Taiwan. Mixedeffect model was constructed to analyze the repeated measurements and determine the relationship among the BMI, WHOQOL scores, and other covariates. Results: One hundred and two patients who received bariatric surgery joined this study. Totally 200 healthy subjects were selected from national health survey. Mixed effect model showed that the physical, psychological and social domains could be improved one-month after bariatric surgery through weight reduction and improvement of co-morbidities, but there were a dip in scores of physical and psychological domains during 3-6 months after operation, apparently related to complications. All of them improved gradually during 6th to 12th months after operation and reached the similar level of healthy referents. Conclusions: The HRQOL improved dramatically along with the reduction of BMI after bariatric surgery, but it usually dips or diminishes during 3-6 months because of complication, and then further improves up to the end of first year. This information can assist clinicians on the pre- and postoperative cares of such patients.
M1046 Fatigue in Patients With Primary Sclerosing Cholangitis: An International Survey Study in Two Population-Based Patient Cohorts Maria Benito de Valle, Monira Rahman, Björn Lindkvist, Einar Bjornsson, Roger W. Chapman, Evangelos Kalaitzakis Fatigue is considered to be common in chronic cholestatic liver disease. However, data on fatigue and its potential relation to health-related quality of life (QoL) in patients with primary sclerosing cholangitis (PSC) are scarce. We aimed to evaluate fatigue in two European population-based PSC patient cohorts. Methods All PSC patients within Vastragotaland, Sweden (n=220) (population 1.5 mmillion) and Oxfordshire, England (n=60) (population 640000) were identified and asked to fill in four validated questionnaires: the Fatigue Impact Scale (FIS), the Chronic Liver Disease Questionnaire (CLDQ, disease-specific QoL instrument), the Short-Form 36 (SF-36, generic QoL instrument) and the Hospital Anxiety and Depression Scale (HAD). Individuals scoring >50% of the maximum score in any FIS domain were considered to have significant fatigue. FIS results were compared to those obtained from age- and gender-matched controls from the general population. Any symptom on CLDQ occurring more often than “some of the time” was considered significant. Clinical and biochemical data were also analyzed. Results A total of 182/292 (62%) patients agreed to participate (mean age 50 (SD 16), 30% F, 82% with inflammatory bowel disease (IBD), 12% post-transplant). The proportions of individuals with significant fatigue (FIS) did not
AGA Abstracts
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differ significantly between PSC patients and controls (16% vs 21%, p>0.05). According to CLDQ, 15% of patients had significant pruritus, 11% fatigue, 11% body pain and 10% mouth dryness. Patients with compared to those without significant fatigue on CLDQ had lower scores in all SF-36 domains (p<0.05 for all) as well as lower SF-36 physical (32.9 (14.2) vs 48.9 (9.5), p<0.05) and mental (32.2 (16.5) vs 46.9 (10.4), p<0.05) component summaries. The prevalence of significant fatigue did not differ between transplanted patients and the rest of the cohort (10% vs. 11%, p<0.05). In logistic regression analysis significant fatigue was independently related only to psychosocial (Odds ratio (OR) 1.05, p<0.05) but not to physical or cognitive fatigue scores. In multivariate analysis worse fatigue scores on CLDQ were independently related to higher depression scores (OR -0.17) as well as worse body pain (OR 0.2), mouth dryness (OR 0.15), and shortness of breath (OR 0.16, p<0.05 for all) on CLDQ. Small-duct PSC, the Mayo PSC risk score or IBD were not related to fatigue. Conclusion Fatigue seems to be of concern in a subgroup of PSC patients and it is associated with impaired QoL. Non life-threatening symptoms such as psychological distress and body pain rather than associated IBD or PSC severity seem to be major determinants of fatigue.
AGA Abstracts
Appropriate Indication for Upper Endoscopy Based on ASGE Guidelines and Its Relation With Positive Findings Horacio W. Rubio, Teresa Barcia, Horacio W. Rubio, María Cristina Martinez Bottani, Adriana M. Cea INTRODUCTION:Upper gastrointestinal endoscopy (UGE) is a safe and effective diagnostic procedure, but it is relatively costly and implies certain risk.Several guidelines have been published for its appropriate use ,as the American Society for Gastrointestinal Endoscopy (ASGE). AIMS:To assess if UGE is used appropriately according to ASGE guidelines.To assess the probability of detecting significant lesions by endoscopy in patients with appropriate indication and compared it with the endoscopic findings in patients with inappropriate indication.To assess the appropriateness of the indication according to the specialty of the referring physicians. MATERIALS AND METHODS:We included data from 541 consecutive diagnostic UGE from January 2006 to December 2008 in outpatients referred to our center.We recorded age, sex,diagnosis,endoscopic findings and the specialty of the referring physicians. Endoscopic findings that had direct therapeutic or prognostic consequence were classified as “positive” or as “negative”.Indications were classified as appropriate,inappropriate and doubtful according to ASGE guidelines.For statistical analysis we used X 2 test and multiple logistic regression with a confidence level of 95%. RESULTS:We reviewed UGE reports of 364 (67%) women and177 (33%) men.The mean age was 59.91 ± 16 years (range: 17-98). Patients referred by gastroenterologist were 350(65%),179 (33%) by generalists, 7(1%) by surgeons, and by others 5(1% ).The most frequent referrals were upper abdominal pain in 195 (36%) patients, heartburn in 131(24%),iron deficiency anemia in 27( 5%),dyspepsia in 13 (2%) and others in 175 (32%).Indications were classified as appropriate in 330 (61%) cases,inappropriate in 133 (25%) and doubtful in 78 (14%). Positive endoscopic findings were reported in 288 (53%) patients, in 182(55%) with appropriate indication, in 64(48%) with inappropriate indication and 42(54%) in doubtful (p = 0, 38).The clinicians referrals showed the highest percentage of positive endoscopic findings. CONCLUSIONS:This study showed a significant frequency of inappropriate indications for UGE according to ASGE guidelines. The presence of positive endoscopic findings was not related to the appropriateness of the indication, but to the speciality of the referring physicians . This study showed that current guidelines regarding the appropriateneness of UGE are relatively inefficient in excluiding significant endoscopic findings
M1047 Quality-of-Life Benefits for Adalimumab-Treated Patients With Moderate to Severe Crohn's Disease are Predicted by Early Mucosal Healing Status Paul J. Rutgeerts, Roopal Thakkar, Eric Q. Wu, Anna Kaltenboeck, Mei Yang, Parvez Mulani, Jingdong Chao INTRODUCTION: Using data from EXTend the Safety and Efficacy of Adalimumab Through ENDoscopic Healing (EXTEND), we evaluated whether early mucosal healing status predicts long-term quality-of-life (QOL) outcomes for patients with moderate to severe Crohn's disease (CD). METHODS: EXTEND was a randomized, placebo-controlled study of patients with moderate to severe ileocolonic CD (Crohn's Disease Activity Index 220-450). All patients received open-label adalimumab 160-/80-mg induction therapy at Weeks 0/2 and were randomized at Week 4 to maintenance therapy with adalimumab 40 mg every other week or placebo. From Week 8, patients with flares or nonresponse could receive open-label adalimumab. Patients underwent an endoscopic assessment of mucosal activity at baseline, Week 12, and Week 52. In this post-hoc analysis, only patients randomized to adalimumab who had nonmissing endoscopic assessment scores (either consensus score or endoscopists' observation) at Week 12 were included. The associations between QOL outcomes, as measured by the Inflammatory Bowel Disease Questionnaire (IBDQ), at Week 52 and assessments of endoscopic disease activity at Week 12, as measured by the Simple Endoscopic Score for Crohn's Disease (SES-CD) scores, were examined. Data were analyzed using multiple linear regressions, controlling for baseline characteristics such as age, weight, sex, disease duration, and IBDQ score at Week 12. RESULTS: Of the 62 patients included in the analysis, 20 demonstrated mucosal healing and 42 had evidence of mucosal ulceration at Week 12. Multivariate analysis showed significant predictive effects of Week-12 endoscopic assessment scores for Week-52 QOL outcomes. Each 1-point decrease in Week-12 SES-CD score was associated with a 2-point increase in Week-52 IBDQ score (p<0.05). CONCLUSIONS: Mucosal healing status at Week 12 predicted 1-year QOL outcomes, as measured by IBDQ scores, with statistically significant predictive utility for adalimumab-treated patients with CD. With appropriate treatment for CD, early mucosal healing may represent an indicator for sustained long-term improvements in patient QOL.
M1045 Is Sexual Dysfunction in Women After Restorative Proctocolectomy With Ileal Pouch Anal Anastomosis Caused by Autonomic Pelvic Nerve Damage? - A Prospective Clinical Trial Jan Wind, Malaika Vlug, Ellen T. Laan, Rik H. van Lunsen, Paul van Koperen, Sebastiaan W. Polle, Willem Bemelman Introduction Sexual dysfunction after restorative proctocolectomy with ileal pouch anal anastomosis (IPAA) is common. The most systematic physical reaction to sexual stimulation is an increase in vaginal vasocongestion. Genital response can be assessed by vaginal pulse amplitude (VPA) using vaginal photoplethysmography. The objective of the present study was to assess whether restorative proctocolectomy with ileo pouch anal anastomosis is associated with autonomic pelvic nerve damage and changes in subjective indices of sexual function in women. Methods Female patients undergoing IPAA between April 2004 and January 2006 were included. During sexual stimulation (visual and vibrotactile) changes in vaginal vasocongestion were measured by vaginal photoplethysmography. Concurrently, quality of life (SF-36) and sexual functioning (FSFI, FSDS) were assessed using validated questionnaires. Endpoints were difference in VPA, feelings of sexual arousal and estimated lubrication pre- and postoperatively and difference in psychological - and sexual functioning pre - and postoperatively. Results Eleven patients were included. For 8 patients (median age 37 [22-49 yrs]) pre- and post-operative data were collected. VPA analysis showed a significant reduction in vaginal vasocongestion during sexual stimulation post-operatively, P=0.012. Subjective sexual arousal and estimated lubrication during the experiment, reported psychological and sexual functioning pre- and postoperative were not different. Conclusions Vaginal vasocongestion after IPAA was significantly reduced; indicating that IPAA in women may be associated with autonomic pelvic nerve damage or partial devascularisation of the vagina. Subjectively reported sexual arousal, estimated lubrication, psychological and sexual functioning were not diminished. Future research should focus on the possible advantage of a full close rectal dissection in these patients.
M1048 Dynamic Improvements of Health-Related Quality After Bariatric Surgery: A One Year Follow-up Chi-Yang Chang, Chih-Kun Huang, Chi-Ming Tai, Jaw-Town Lin, Jung-Der Wang Objective: The aim of this study was to evaluate the effects of bariatric surgery on the dynamic changes of HRQOL and reduction of co-morbidities along with loss of excess BMI during one year follow-up. Background: Bariatric surgery could reduce body weight and improve health-related quality of life (HRQOL) effectively for subjects with morbid obesity, but no study has shown detailed profiles of HRQOL changes along with time. Methods: Patients were enrolled for bariatric surgery by a modified recommendation of the AsiaPacific consensus. The Taiwan version of WHOQOL-BREF was administered 1 month before the operation, 1, 3, 6, and 12 months after surgery. BMI, co-morbidities and operation related complications were also measured simultaneously. A healthy reference group was randomly sampled from the database of National Health Interview Survey in Taiwan. Mixedeffect model was constructed to analyze the repeated measurements and determine the relationship among the BMI, WHOQOL scores, and other covariates. Results: One hundred and two patients who received bariatric surgery joined this study. Totally 200 healthy subjects were selected from national health survey. Mixed effect model showed that the physical, psychological and social domains could be improved one-month after bariatric surgery through weight reduction and improvement of co-morbidities, but there were a dip in scores of physical and psychological domains during 3-6 months after operation, apparently related to complications. All of them improved gradually during 6th to 12th months after operation and reached the similar level of healthy referents. Conclusions: The HRQOL improved dramatically along with the reduction of BMI after bariatric surgery, but it usually dips or diminishes during 3-6 months because of complication, and then further improves up to the end of first year. This information can assist clinicians on the pre- and postoperative cares of such patients.
M1046 Fatigue in Patients With Primary Sclerosing Cholangitis: An International Survey Study in Two Population-Based Patient Cohorts Maria Benito de Valle, Monira Rahman, Björn Lindkvist, Einar Bjornsson, Roger W. Chapman, Evangelos Kalaitzakis Fatigue is considered to be common in chronic cholestatic liver disease. However, data on fatigue and its potential relation to health-related quality of life (QoL) in patients with primary sclerosing cholangitis (PSC) are scarce. We aimed to evaluate fatigue in two European population-based PSC patient cohorts. Methods All PSC patients within Vastragotaland, Sweden (n=220) (population 1.5 mmillion) and Oxfordshire, England (n=60) (population 640000) were identified and asked to fill in four validated questionnaires: the Fatigue Impact Scale (FIS), the Chronic Liver Disease Questionnaire (CLDQ, disease-specific QoL instrument), the Short-Form 36 (SF-36, generic QoL instrument) and the Hospital Anxiety and Depression Scale (HAD). Individuals scoring >50% of the maximum score in any FIS domain were considered to have significant fatigue. FIS results were compared to those obtained from age- and gender-matched controls from the general population. Any symptom on CLDQ occurring more often than “some of the time” was considered significant. Clinical and biochemical data were also analyzed. Results A total of 182/292 (62%) patients agreed to participate (mean age 50 (SD 16), 30% F, 82% with inflammatory bowel disease (IBD), 12% post-transplant). The proportions of individuals with significant fatigue (FIS) did not
AGA Abstracts
S-320