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P046 - Health-related quality of life in patients with IBD Comparing groups with short-and long-term disease duration
Abstracts of the 4th Congress of ECCO
the European Crohn’s and Colitis Organisation
relation to the ovaries (n = 3), abdominal aortic aneurism and suspected aortic dissection (n = 1), abdominal abscess (n = 1), severe inflammatory or infectious small bowel disorder (n = 2), a large artefarct (n = 1) and suspected colon neoplasia (n = 3). There were 27 succeeding interventions in 19 patients (5.9%): Radiological procedures (n = 9), gynaecological examination (n = 6), endoscopy (n = 5), surgery (n = 3), laboratory tests (n = 2) and medical treatment (n = 2). Examinations revealed six pathological condtions: Abdominal aortic aneurism, prostate cancer, adenocarcinoma in the terminal ileum, hepatic hemangioma, gastrointestinal tuberculosis and retention of a capsule endoscope. Seven scans were false positive and in seven cases there were no follow-up data. Conclusion: Clinically important incidental findings were revealed in 8.0%, and more common in patients with suspected CD. Two patients were diagnosed with malignant disease (0.6%). These results emphasize the importance of looking beyond the small bowel when performing MR-enterography. Further prospective studies are necessary to clarify this issue. Reference(s) [1] Zalis ME, Barish MA, Choi JR et al. CT colonography reporting and data system: a consensus proposal. Radiology 2005; 236(1): 3 9. P046 Health-related quality of life in patients with IBD Comparing groups with short-and long-term disease duration S. J¨ aghult *, J. Larson, U. Johansson, R. Wredling, M. Kapraali. Karolinska Institutet, Stockholm, Sweden Introduction: Inflammatory bowel diseases (IBD) include Crohn’s disease and ulcerative colitis. IBD are chronic diseases and are characterized by alternating periods of remission with relapses. Studies have shown that patients with IBD rate their health-related quality of life lower, as compared with a general population. Few studies have been made to investigate if disease duration leads to changes in patients’ health-related quality of life. The aim of this study is to assess health-related quality of life among IBD patients with short and long disease duration and to identify predictors of health-related quality of life among these patients. Methods: Patients with a confirmed diagnosis of Crohn’s disease or ulcerative colitis, in clinical remission and receiving care at the IBD clinic at Danderyds Hospital were invited to participate in this cross-sectional study. The patient inclusion criteria were that disease duration should be less than two years (shortduration group) or more than five years (long-duration group), they should have no other chronic disease, they should have a good understanding of the Swedish language and be able to fill out a questionnaire. The study population was divided in a Crohn’s disease group (44 patients had disease duration less than two years, and 39 had more than five years) and an ulcerative colitis group (40 patients had disease duration of less than two years, and 74 had more than five years). The Health Index, The Sense of Coherence questionnaire, The Inflammatory Bowel Disease Questionnaire and the Rating Form of IBD Patient Concerns were used to measure health-related quality of life. Results: Among patients with Crohn’s disease, statistical differences were found in the majority of variables, showing that the short-duration group had a lower perceived healthrelated quality of life. When comparing ulcerative colitis patients no significant differences could be found between the groups. The results from the Rating Form of IBD Patient Concerns gave information about which areas that gives most concerns. Both patients with Crohn’s disease and ulcerative colitis and with short disease duration reported high concern about items regarding developing cancer, being a burden on others, having surgery, having an ostomy bag, uncertain nature of disease and effect on medication.
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Conclusion: This study shows that patients with Crohn’s disease with long disease duration experienced a better health-related quality of life when comparing with the short-duration group, and those patients in the short-duration group are in the greatest need of education and support. When comparing ulcerative colitis patients with short and long disease duration no significant differences could be found. The results from the RFIPC instrument gives knowledge about which areas that gives most concern for the patients and can improve the patient education in an evidence-based perspective. P047 Prospective assessment of the effect on quality of life of healing perineal Crohn’s fistulas with anti-tumour necrosis factor therapy S.C. Ng1 *, S. Plamondon1 , M.A. Kamm2 . 1 St Mark’s Hospital, London, United Kingdom, 2 St Vincent’s Hospital, University of Melbourne, Melbourne, Australia Background: Anti-tumour necrosis factor (TNF) therapy is effective in the treatment of perianal Crohn’s disease. We evaluated the effects of Infliximab and Adalimumab on healthrelated quality of life (HRQoL) of patients with perineal fistulising Crohn’s disease. Methods: Prospective evaluation of HRQoL assessment using Inflammatory Bowel Disease Questionnaire (IBDQ) which include four categories: bowel, emotional, social and systemic symptoms, scored on a 7-point Likert scale from 1 (poorest) to 7 (optimum function) [range 32 224]. A total IBDQ score of 170 is associated with clinical remission, and a change of 16 points is regarded as clinically meaningful. Outcome measures were the change of IBDQ score from baseline up to one year of treatment, and the correlation of changes in IBDQ score with clinical and deep tissue healing based on magnetic resonance imaging (MRI). Results: Twenty-six patients with perineal fistulising Crohn’s disease were treated (19 infliximab, 7 adalimumab). Prior to anti-TNF therapies, 22 of 26 (85%) patients had impaired total IBDQ scores (170). The mean baseline IBDQ score was 137 for infliximab-treated patients and 138 for adalimumab-treated patients. At one year, the mean change in total score for patients who had infliximab and adalimumab was a gain of 40 and 41 points, respectively. Fourteen patients on infliximab and six on adalimumab achieved a total score of 170. After one year of treatment, the mean change in IBDQ score for all treated patients was a gain of 50 points in those who had clinical fistula closure and 34 points in those who had a clinical response (>50% reduction in draining fistulas). The mean increase in score from baseline was significantly higher for patients who achieved MRI improvement/healing (55 points) than those who had no MRI improvement (9 points; p < 0.05). Conclusion: Anti-TNF therapy improves HRQoL in patients with perineal fistulising Crohn’s disease at one year. This improvement is most pronounced in patients who achieved clinical and deep tissue healing. Reference(s) [1] Irvine EJ. Assessing outcomes in clinical trials. In: Satsangi J, Sutherland LR, eds. Inflammatory Bowel Diseases. London: Churchill Livingstone; 2003: 319 333. [2] Irvine et al. Gastroenterology 1994; 106: 287 296. [3] Gregor JC et al. Inflam Bowel Dis 1997; 3: 265 76.
the European Crohn’s and Colitis Organisation
relation to the ovaries (n = 3), abdominal aortic aneurism and suspected aortic dissection (n = 1), abdominal abscess (n = 1), severe inflammatory or infectious small bowel disorder (n = 2), a large artefarct (n = 1) and suspected colon neoplasia (n = 3). There were 27 succeeding interventions in 19 patients (5.9%): Radiological procedures (n = 9), gynaecological examination (n = 6), endoscopy (n = 5), surgery (n = 3), laboratory tests (n = 2) and medical treatment (n = 2). Examinations revealed six pathological condtions: Abdominal aortic aneurism, prostate cancer, adenocarcinoma in the terminal ileum, hepatic hemangioma, gastrointestinal tuberculosis and retention of a capsule endoscope. Seven scans were false positive and in seven cases there were no follow-up data. Conclusion: Clinically important incidental findings were revealed in 8.0%, and more common in patients with suspected CD. Two patients were diagnosed with malignant disease (0.6%). These results emphasize the importance of looking beyond the small bowel when performing MR-enterography. Further prospective studies are necessary to clarify this issue. Reference(s) [1] Zalis ME, Barish MA, Choi JR et al. CT colonography reporting and data system: a consensus proposal. Radiology 2005; 236(1): 3 9. P046 Health-related quality of life in patients with IBD Comparing groups with short-and long-term disease duration S. J¨ aghult *, J. Larson, U. Johansson, R. Wredling, M. Kapraali. Karolinska Institutet, Stockholm, Sweden Introduction: Inflammatory bowel diseases (IBD) include Crohn’s disease and ulcerative colitis. IBD are chronic diseases and are characterized by alternating periods of remission with relapses. Studies have shown that patients with IBD rate their health-related quality of life lower, as compared with a general population. Few studies have been made to investigate if disease duration leads to changes in patients’ health-related quality of life. The aim of this study is to assess health-related quality of life among IBD patients with short and long disease duration and to identify predictors of health-related quality of life among these patients. Methods: Patients with a confirmed diagnosis of Crohn’s disease or ulcerative colitis, in clinical remission and receiving care at the IBD clinic at Danderyds Hospital were invited to participate in this cross-sectional study. The patient inclusion criteria were that disease duration should be less than two years (shortduration group) or more than five years (long-duration group), they should have no other chronic disease, they should have a good understanding of the Swedish language and be able to fill out a questionnaire. The study population was divided in a Crohn’s disease group (44 patients had disease duration less than two years, and 39 had more than five years) and an ulcerative colitis group (40 patients had disease duration of less than two years, and 74 had more than five years). The Health Index, The Sense of Coherence questionnaire, The Inflammatory Bowel Disease Questionnaire and the Rating Form of IBD Patient Concerns were used to measure health-related quality of life. Results: Among patients with Crohn’s disease, statistical differences were found in the majority of variables, showing that the short-duration group had a lower perceived healthrelated quality of life. When comparing ulcerative colitis patients no significant differences could be found between the groups. The results from the Rating Form of IBD Patient Concerns gave information about which areas that gives most concerns. Both patients with Crohn’s disease and ulcerative colitis and with short disease duration reported high concern about items regarding developing cancer, being a burden on others, having surgery, having an ostomy bag, uncertain nature of disease and effect on medication.
S29
Conclusion: This study shows that patients with Crohn’s disease with long disease duration experienced a better health-related quality of life when comparing with the short-duration group, and those patients in the short-duration group are in the greatest need of education and support. When comparing ulcerative colitis patients with short and long disease duration no significant differences could be found. The results from the RFIPC instrument gives knowledge about which areas that gives most concern for the patients and can improve the patient education in an evidence-based perspective. P047 Prospective assessment of the effect on quality of life of healing perineal Crohn’s fistulas with anti-tumour necrosis factor therapy S.C. Ng1 *, S. Plamondon1 , M.A. Kamm2 . 1 St Mark’s Hospital, London, United Kingdom, 2 St Vincent’s Hospital, University of Melbourne, Melbourne, Australia Background: Anti-tumour necrosis factor (TNF) therapy is effective in the treatment of perianal Crohn’s disease. We evaluated the effects of Infliximab and Adalimumab on healthrelated quality of life (HRQoL) of patients with perineal fistulising Crohn’s disease. Methods: Prospective evaluation of HRQoL assessment using Inflammatory Bowel Disease Questionnaire (IBDQ) which include four categories: bowel, emotional, social and systemic symptoms, scored on a 7-point Likert scale from 1 (poorest) to 7 (optimum function) [range 32 224]. A total IBDQ score of 170 is associated with clinical remission, and a change of 16 points is regarded as clinically meaningful. Outcome measures were the change of IBDQ score from baseline up to one year of treatment, and the correlation of changes in IBDQ score with clinical and deep tissue healing based on magnetic resonance imaging (MRI). Results: Twenty-six patients with perineal fistulising Crohn’s disease were treated (19 infliximab, 7 adalimumab). Prior to anti-TNF therapies, 22 of 26 (85%) patients had impaired total IBDQ scores (170). The mean baseline IBDQ score was 137 for infliximab-treated patients and 138 for adalimumab-treated patients. At one year, the mean change in total score for patients who had infliximab and adalimumab was a gain of 40 and 41 points, respectively. Fourteen patients on infliximab and six on adalimumab achieved a total score of 170. After one year of treatment, the mean change in IBDQ score for all treated patients was a gain of 50 points in those who had clinical fistula closure and 34 points in those who had a clinical response (>50% reduction in draining fistulas). The mean increase in score from baseline was significantly higher for patients who achieved MRI improvement/healing (55 points) than those who had no MRI improvement (9 points; p < 0.05). Conclusion: Anti-TNF therapy improves HRQoL in patients with perineal fistulising Crohn’s disease at one year. This improvement is most pronounced in patients who achieved clinical and deep tissue healing. Reference(s) [1] Irvine EJ. Assessing outcomes in clinical trials. In: Satsangi J, Sutherland LR, eds. Inflammatory Bowel Diseases. London: Churchill Livingstone; 2003: 319 333. [2] Irvine et al. Gastroenterology 1994; 106: 287 296. [3] Gregor JC et al. Inflam Bowel Dis 1997; 3: 265 76.