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Quality of life in inflammatory bowel disease: Cross sectional survey of a community population
m +/- SEM) was sigmficantly reduced compared to that of the year preceding pregnancy (1.07 +A O16, p = 0.02) and that of the year following delivery (1.15 +/- 0.16, p = 0.01). In non-smoking women (n = 48), there was no significant change of HB score between periods. In women who smoked (n = 22, most of them (n = 18) reduced markedly tobacco consumption during pregnancy), mean HB score during pregnancy (0.58 +/- 0.20) was significantly reduced compared to mean HB score of the year following delivery (1.60 +/0.33, p = 0.01). The overall use of maintenance treatments (saficylates, steroids, azathioprine) was reduced during pregnancy Conclusions : CD activity was mildly but significantly reduced during pregnancy, despite, in the same time, a reduction in the overall use of maintenance treatment. The reduction of tobacco consumption during pregnancy ni smokers may at least partly explain this improvement.
(p<0.05), and to age matched UC controls diagnosed < 40 yrs (5.9%; 1 of 17 patients) (p0.05). Active smoking was less frequent in pts with UC diagnosed >40 yrs (12%; 3 of 25 pts) compared to CD diagnosed >40 yrs (56%; 19 of 34 pts with p
S1437 S1434
Quality of Life in Inflammatory Bowel Disease: Cross Sectional Survey of a Community Population
Defining the natural history of Crohn's disease behavior prospectively: Categorization of newly diagnosed pediatric patients using Vienna classification
Greg Rubin, Pafi Hungin, David Chinn, Deepak Dwarakanath Introduction. Impaired health related quality of life (HRQoL) is a recognised feature of the inflammatory bowel diseases (IBD)(ulcerative colitis and Crohns disease). Poor HRQoL is related to type and severity of disease, as well as to features unrelated to the disease such as gender, age, cultural factors and coping strategies. These findings have been derived from selected populations, most commonly hospital outpatients, and may not reflect the characteristics of patients with IBD in the community where less than half of all patients are definitely under specialist care. The aim of this study was to describe HRQoL in a community-based sample of patients with established IBD and explore its assooation with type and extent of disease, gender, age, social deprivation and other factors. Methods. Patients with IBD were identified from a systematic search of the computer diagnostic and prescribing records of 23 of 25 family practices forming a single Primary Care Organisation in NorthEast England. The combined practice population was 163,383. Patients under the age of 16 and those who had undergone total colectomy were excluded. We selected patients who had established IBD, defined as having been diagnosed at least 2 years previously, in order to describe the sustained rather than initial impact of IBD on HRQoL. Quality of life (QoL) was assessed by self-completion of the UK version of the IBDQ originally developed by Guyatt et al and validated for self-administration This contains 30 questions with possible total score ranging from 30 (worst) to 120. Results. Questionnaires were mailed to 556 subjects, with a 73.6% response. The median total score was 98 (mean 94.1, IQR 83-108). The distributions of total score and most domain scores were skewed. Lower scores were significantly associated with female gender, Crohns disease, more extensive disease (UC) and being under specialist care Mean HRQoL score was significantly lower for patients living in more deprived districts, and was independent of type and extent of disease. However, these patients were no less likely to be under specialist care. Conclusions. In patients with established IBD, most patients experience only minor impairment of HRQoL, with mean total and domain scores being similar to those described for hospital outpatients with disease in remission. Patients with Crohns disease and women are most affected. Clinicians responsible for the care of patients with IBD should be aware of these more vulnerable groups.
Subra Kugathasan, Janice Heikenen, Robert Judd, Christopher Brown, David Binion The natural history of CD has not been fully defined using population-based models. Pediatric CD may represent an optimal population for defining the natural history of disease, as patients may be tracked from the time of diagnosis, and the emergence of stricturing and hstuliznig complications can be identified prospectively. The Vienna classification of CD distinguishes pts by age of onset, disease behavior and anatomic involvement. We applied the Vienna classification to a cohort of newly diagnosed CD children from a prospective statewide survey to characterize disease pattern at onset. Methods: The Wisconsin Pediatric IBD Alliance has prospectively identified all new. diagnoses of CD in children under age 18 using a voluntary reporting survey from 100% of pediatric subspecialists providnig care for Wl children from 1/1/00 to 12/31/01. Vienna classification of CD was applied (Gasche C, et al. Inflamm Bowel Dis 2000; 6:8-15). Results: There were 128 children who met smct cnteria for CD diagnosis. Age vaned from 2 to 18y, with a mean age of 12.6 -+4.5y. There were significantly more males compared to females (1.8:1; p = <0.02). Disease behavior slgnificandy favored an inflammatory phenotype at the time of diagnosis compared to adults (90% v 52.4%), compared to stricturing (2% v 21.7%) and penetrating (8% v 25.9%). Anatomic extent of involvement at the time of pediatric CD diagnosis was similar to the original adult cohort, revealing ileal involvement (25% v 26.1%), isolated colonic (32% v 358%), ileocolonic (29% v 23.3%), and upper GI involvement (14% v 14.7%). Conclusions: The natural history of CD, prospectively defined by newly diagnosed pediatric cases in a defined population, demonstrates primarily inflammatory disease behavior at onset. The anatomic extent of disease was essentially identical between pediatric and adult cohorts. $tricturing, and penetrating CD behavior may represent progressive tissue damage and remodeling, which are a sequela of chronic intestinal inflammation Studies correlating CD genotype and phenotype should take into account that disease behavior at the time of diagnosis will infrequently reflect stricturing or penetrating phenotypes.
S1435 S1438 Screening for Dysplasia in Patients with 22 - 40 Years of Ulcerative Colitis in a
Functional Change of Stratum Corneum of the Skin Induced by Long Term Steriod Administration and Creation of Ileostomy in Patients with Ulcerative Colitis
Population-Based Cohort from Copenhagen County Karen V. Winther, Eywin Braun, Thomas Horn, Join Brynskov, Vibeke Binder Background and Aim: Long-tern1 follow-up has documented a low occurrence of colorectal cancer in patients with ulcerative colitis in Copenhagen County The patients have been offered regular clinical control, but surveillance colonoscopy has not been routine. To investigate for posstble dysplasia in patients with very long disease duration we performed a prospective colonoscopy screening of patients recruited from our population-based cohort in Copenhagen County Patients and Methods: Inclusion criteria were l) diagnosis between 1962 -1980 and 2) affection beyond the sigmoid colon at diagnosis or later. Multiple random biopsies were collected, at least hmr from each of eight colon segments plus from suspicious areas. Light microscopic examinations were performed by the same pathologist. Results: 125 patients were included (59 men, 66 women). The median disease duration was 30 years (range, 22-40 years). 80 patients (64%) had taken a 5-ASA medication for more than 12 years. One patient had low-grade dysplasia in the descending colon and one had changes indefinite for dysplasia in the rectum. Tubular adenomas with low-grade and high-grade dysplasia, respectively, were removed in two patients. 67 patients (54%) had a histologically normal colon, whereas 31 (25%) had minimal cryptitis, 19 (15%) had mild to moderately active inflammation and four patients (3%) had severe inflammation. Three patients showed changes suggestive of Crohn's disease. Conclusion: After median 30 years of ulcerative colitis the occurrence of dysplasia is low in this subgroup of a population-based cohort. The data indicate that long disease duration per se is no risk factor for colorectal cancer in patients with either inactive disease or in whom successful inflammatory control can be obtained by long-term 5-ASAtreatment alone.
Hiroo Naito, Yuji Funayama, Kohei Fuknshima, Chikashi Shlbata, Akihiko Hashimoto, lwao Sasaki, Katsuko Kikuchi BACKGROUND:A delicate management of skin is necessary in care of patients with enteral stoma. Especially, a very fine attention should be paid for peristomal skin in patients with ileostomy who are taking a large amount of steroid However, no particular reports have been available referring to the functional change of skin in these patients. AIM: The aim of this study is to elucidate the effect of long term steroid administration and creation of ileostomy on the function of stratum comeum (SC)in patients with ulcerative colitis. SUBJECTS: 6 control patients (non-UC) with colorectal cancer, 13 patients with ulcerative colitis (UC) were studied. Patients of non-UC underwent eolectomy with or without colostomy and no steroid had been given. Contrary, a large amount of steroid compatible to about 7.5g of predonisolone had been administered in patients of UC who encountered with proctcoloctomy and ileostomy .METHODS:At center portion of medial anterior arm, both the transepidermal water loss (TEWL) as an index of barrier function of SC and the conductance of SC (CON) as an index of water holding capacity of SC were measured before operation and at one month following operation. In each measurement, evoked changes of both parameters were evaluated after repeating stimulation by adhesive tape (sTEWL and sCON). RESULTS: 1) Preoperative levels of TEWL in UC (3.5 g/m2/h) were significantly lower than non-UC (5.3), however sTEWL of UC (23.1) were simlllar to non-UC (21.8) Postoperative levels of TEWL and sTEWL were almost same in both UC and non-UC. 2) Preoperative levels of CON of UC (28.1 micromho) were significantly lower than non-UC (70.3), however, sCON showed almost same levels in both group. Postoperative levels of CON demonstrated same tendency as preoperative values. In contrast, sCON was higher in UC than non-UC. CONCLUSION: The water holding capacity of SC in patients with ulcerative colitis is significantly lower than control patients both pre and postoperatively, however, postoperative capacity after stimulation by adhesive tape were higher in UC than non-UC In contrast, the barrier of SC in UC did not deteriorate compared to non-UC These results indicate that careful attention should be paid to dryness of skin both pre and postoperatively in patients with UC who had received a large amount of steroid. In addition, wetness in peristomal skin should be alerted postoperatively in these patients.
$1436
Impact of Pregnancy on the Activity of Crohn's Disease (CD) Francois Agret, Jacques Cosnes, Zahir Hassani, Jean-Marc Gomet, Jean-Pierre Gendre, Marc Lemann, Laurent Beaugerie The impact of pregnancy on CD activity has been poorly investigated. The aim of our study was to determine the effect of pregnancy on CD activity from retrospective analysis of a cohort of women with continuous clinical follow-up. Methods : Eighty-three pregnancies occurring in 73 women with CD continuously followed in our two centers were studied. Harvey-Bradshaw (HB) score was determined for each pregnancy during 11 consecutive trimesters (the 4 trimesters preceding pregnancy, the 3 trimesters of pregnancy and the 4 trimesters following delivery). Results : Mean HB score during pregnancy (0.71 +/- 0.16,
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AGA Abstracts
(p<0.05), and to age matched UC controls diagnosed < 40 yrs (5.9%; 1 of 17 patients) (p
S1437 S1434
Quality of Life in Inflammatory Bowel Disease: Cross Sectional Survey of a Community Population
Defining the natural history of Crohn's disease behavior prospectively: Categorization of newly diagnosed pediatric patients using Vienna classification
Greg Rubin, Pafi Hungin, David Chinn, Deepak Dwarakanath Introduction. Impaired health related quality of life (HRQoL) is a recognised feature of the inflammatory bowel diseases (IBD)(ulcerative colitis and Crohns disease). Poor HRQoL is related to type and severity of disease, as well as to features unrelated to the disease such as gender, age, cultural factors and coping strategies. These findings have been derived from selected populations, most commonly hospital outpatients, and may not reflect the characteristics of patients with IBD in the community where less than half of all patients are definitely under specialist care. The aim of this study was to describe HRQoL in a community-based sample of patients with established IBD and explore its assooation with type and extent of disease, gender, age, social deprivation and other factors. Methods. Patients with IBD were identified from a systematic search of the computer diagnostic and prescribing records of 23 of 25 family practices forming a single Primary Care Organisation in NorthEast England. The combined practice population was 163,383. Patients under the age of 16 and those who had undergone total colectomy were excluded. We selected patients who had established IBD, defined as having been diagnosed at least 2 years previously, in order to describe the sustained rather than initial impact of IBD on HRQoL. Quality of life (QoL) was assessed by self-completion of the UK version of the IBDQ originally developed by Guyatt et al and validated for self-administration This contains 30 questions with possible total score ranging from 30 (worst) to 120. Results. Questionnaires were mailed to 556 subjects, with a 73.6% response. The median total score was 98 (mean 94.1, IQR 83-108). The distributions of total score and most domain scores were skewed. Lower scores were significantly associated with female gender, Crohns disease, more extensive disease (UC) and being under specialist care Mean HRQoL score was significantly lower for patients living in more deprived districts, and was independent of type and extent of disease. However, these patients were no less likely to be under specialist care. Conclusions. In patients with established IBD, most patients experience only minor impairment of HRQoL, with mean total and domain scores being similar to those described for hospital outpatients with disease in remission. Patients with Crohns disease and women are most affected. Clinicians responsible for the care of patients with IBD should be aware of these more vulnerable groups.
Subra Kugathasan, Janice Heikenen, Robert Judd, Christopher Brown, David Binion The natural history of CD has not been fully defined using population-based models. Pediatric CD may represent an optimal population for defining the natural history of disease, as patients may be tracked from the time of diagnosis, and the emergence of stricturing and hstuliznig complications can be identified prospectively. The Vienna classification of CD distinguishes pts by age of onset, disease behavior and anatomic involvement. We applied the Vienna classification to a cohort of newly diagnosed CD children from a prospective statewide survey to characterize disease pattern at onset. Methods: The Wisconsin Pediatric IBD Alliance has prospectively identified all new. diagnoses of CD in children under age 18 using a voluntary reporting survey from 100% of pediatric subspecialists providnig care for Wl children from 1/1/00 to 12/31/01. Vienna classification of CD was applied (Gasche C, et al. Inflamm Bowel Dis 2000; 6:8-15). Results: There were 128 children who met smct cnteria for CD diagnosis. Age vaned from 2 to 18y, with a mean age of 12.6 -+4.5y. There were significantly more males compared to females (1.8:1; p = <0.02). Disease behavior slgnificandy favored an inflammatory phenotype at the time of diagnosis compared to adults (90% v 52.4%), compared to stricturing (2% v 21.7%) and penetrating (8% v 25.9%). Anatomic extent of involvement at the time of pediatric CD diagnosis was similar to the original adult cohort, revealing ileal involvement (25% v 26.1%), isolated colonic (32% v 358%), ileocolonic (29% v 23.3%), and upper GI involvement (14% v 14.7%). Conclusions: The natural history of CD, prospectively defined by newly diagnosed pediatric cases in a defined population, demonstrates primarily inflammatory disease behavior at onset. The anatomic extent of disease was essentially identical between pediatric and adult cohorts. $tricturing, and penetrating CD behavior may represent progressive tissue damage and remodeling, which are a sequela of chronic intestinal inflammation Studies correlating CD genotype and phenotype should take into account that disease behavior at the time of diagnosis will infrequently reflect stricturing or penetrating phenotypes.
S1435 S1438 Screening for Dysplasia in Patients with 22 - 40 Years of Ulcerative Colitis in a
Functional Change of Stratum Corneum of the Skin Induced by Long Term Steriod Administration and Creation of Ileostomy in Patients with Ulcerative Colitis
Population-Based Cohort from Copenhagen County Karen V. Winther, Eywin Braun, Thomas Horn, Join Brynskov, Vibeke Binder Background and Aim: Long-tern1 follow-up has documented a low occurrence of colorectal cancer in patients with ulcerative colitis in Copenhagen County The patients have been offered regular clinical control, but surveillance colonoscopy has not been routine. To investigate for posstble dysplasia in patients with very long disease duration we performed a prospective colonoscopy screening of patients recruited from our population-based cohort in Copenhagen County Patients and Methods: Inclusion criteria were l) diagnosis between 1962 -1980 and 2) affection beyond the sigmoid colon at diagnosis or later. Multiple random biopsies were collected, at least hmr from each of eight colon segments plus from suspicious areas. Light microscopic examinations were performed by the same pathologist. Results: 125 patients were included (59 men, 66 women). The median disease duration was 30 years (range, 22-40 years). 80 patients (64%) had taken a 5-ASA medication for more than 12 years. One patient had low-grade dysplasia in the descending colon and one had changes indefinite for dysplasia in the rectum. Tubular adenomas with low-grade and high-grade dysplasia, respectively, were removed in two patients. 67 patients (54%) had a histologically normal colon, whereas 31 (25%) had minimal cryptitis, 19 (15%) had mild to moderately active inflammation and four patients (3%) had severe inflammation. Three patients showed changes suggestive of Crohn's disease. Conclusion: After median 30 years of ulcerative colitis the occurrence of dysplasia is low in this subgroup of a population-based cohort. The data indicate that long disease duration per se is no risk factor for colorectal cancer in patients with either inactive disease or in whom successful inflammatory control can be obtained by long-term 5-ASAtreatment alone.
Hiroo Naito, Yuji Funayama, Kohei Fuknshima, Chikashi Shlbata, Akihiko Hashimoto, lwao Sasaki, Katsuko Kikuchi BACKGROUND:A delicate management of skin is necessary in care of patients with enteral stoma. Especially, a very fine attention should be paid for peristomal skin in patients with ileostomy who are taking a large amount of steroid However, no particular reports have been available referring to the functional change of skin in these patients. AIM: The aim of this study is to elucidate the effect of long term steroid administration and creation of ileostomy on the function of stratum comeum (SC)in patients with ulcerative colitis. SUBJECTS: 6 control patients (non-UC) with colorectal cancer, 13 patients with ulcerative colitis (UC) were studied. Patients of non-UC underwent eolectomy with or without colostomy and no steroid had been given. Contrary, a large amount of steroid compatible to about 7.5g of predonisolone had been administered in patients of UC who encountered with proctcoloctomy and ileostomy .METHODS:At center portion of medial anterior arm, both the transepidermal water loss (TEWL) as an index of barrier function of SC and the conductance of SC (CON) as an index of water holding capacity of SC were measured before operation and at one month following operation. In each measurement, evoked changes of both parameters were evaluated after repeating stimulation by adhesive tape (sTEWL and sCON). RESULTS: 1) Preoperative levels of TEWL in UC (3.5 g/m2/h) were significantly lower than non-UC (5.3), however sTEWL of UC (23.1) were simlllar to non-UC (21.8) Postoperative levels of TEWL and sTEWL were almost same in both UC and non-UC. 2) Preoperative levels of CON of UC (28.1 micromho) were significantly lower than non-UC (70.3), however, sCON showed almost same levels in both group. Postoperative levels of CON demonstrated same tendency as preoperative values. In contrast, sCON was higher in UC than non-UC. CONCLUSION: The water holding capacity of SC in patients with ulcerative colitis is significantly lower than control patients both pre and postoperatively, however, postoperative capacity after stimulation by adhesive tape were higher in UC than non-UC In contrast, the barrier of SC in UC did not deteriorate compared to non-UC These results indicate that careful attention should be paid to dryness of skin both pre and postoperatively in patients with UC who had received a large amount of steroid. In addition, wetness in peristomal skin should be alerted postoperatively in these patients.
$1436
Impact of Pregnancy on the Activity of Crohn's Disease (CD) Francois Agret, Jacques Cosnes, Zahir Hassani, Jean-Marc Gomet, Jean-Pierre Gendre, Marc Lemann, Laurent Beaugerie The impact of pregnancy on CD activity has been poorly investigated. The aim of our study was to determine the effect of pregnancy on CD activity from retrospective analysis of a cohort of women with continuous clinical follow-up. Methods : Eighty-three pregnancies occurring in 73 women with CD continuously followed in our two centers were studied. Harvey-Bradshaw (HB) score was determined for each pregnancy during 11 consecutive trimesters (the 4 trimesters preceding pregnancy, the 3 trimesters of pregnancy and the 4 trimesters following delivery). Results : Mean HB score during pregnancy (0.71 +/- 0.16,
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AGA Abstracts