Effect of intestinal resection on quality of life in Crohn's disease

Emily K Wright; Michael A Kamm; Peter De Cruz; Amy L Hamilton; Kathryn J Ritchie; Efrosinia O Krejany; Alexandra Gorelik; Danny Liew; Lani Prideaux; Ian C Lawrance; Jane M Andrews; Peter A Bampton; Miles P Sparrow; Timothy H Florin; Peter R Gibson; Henry Debinski; Richard B Gearry; Finlay A Macrae; Rupert W Leong; Ian Kronborg; Graeme Radford-Smith; Warwick Selby; Michael J Johnston; Rodney Woods; P Ross Elliott; Sally J Bell; Steven J Brown; William R Connell; Paul V Desmond

doi:10.1093/ecco-jcc/jjv058

Effect of intestinal resection on quality of life in Crohn's disease

J Crohns Colitis. 2015 Jun;9(6):452-62. doi: 10.1093/ecco-jcc/jjv058. Epub 2015 Apr 8.

Authors

Emily K Wright¹, Michael A Kamm², Peter De Cruz¹, Amy L Hamilton¹, Kathryn J Ritchie¹, Efrosinia O Krejany¹, Alexandra Gorelik³, Danny Liew³, Lani Prideaux¹, Ian C Lawrance⁴, Jane M Andrews⁵, Peter A Bampton⁶, Miles P Sparrow⁷, Timothy H Florin⁸, Peter R Gibson⁷, Henry Debinski⁹, Richard B Gearry¹⁰, Finlay A Macrae¹¹, Rupert W Leong¹², Ian Kronborg¹³, Graeme Radford-Smith¹⁴, Warwick Selby¹⁵, Michael J Johnston¹, Rodney Woods¹, P Ross Elliott¹, Sally J Bell¹, Steven J Brown¹, William R Connell¹, Paul V Desmond¹

Affiliations

¹ Department of Gastroenterology, St Vincent's Hospital and University of Melbourne, Melbourne, VIC, Australia.
² Department of Gastroenterology, St Vincent's Hospital and University of Melbourne, Melbourne, VIC, Australia mkamm@unimelb.edu.au.
³ Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, VIC, Australia.
⁴ Centre for Inflammatory Bowel Diseases, Fremantle Hospital and University of Western Australia, Fremantle, WA, Australia.
⁵ Department of Gastroenterology and Hepatology, Royal Adelaide Hospital and University of Adelaide, Adelaide, SA, Australia.
⁶ Department of Gastroenterology and Hepatology, Flinders Medical Centre and Flinders University, Adelaide, SA, Australia.
⁷ Department of Gastroenterology, Alfred Health and Monash University, Melbourne, VIC, Australia.
⁸ Department of Gastroenterology, Mater Health Services, University of Queensland, Brisbane, QLD, Australia.
⁹ Melbourne Gastrointestinal Investigation Unit, Cabrini Hospital, Melbourne, VIC, Australia.
¹⁰ Department of Medicine, University of Otago, Christchurch, New Zealand.
¹¹ Department of Colorectal Medicine and Genetics, and Department of Medicine, Royal Melbourne Hospital and University of Melbourne, Melbourne, VIC, Australia.
¹² Gastroenterology and Liver Services, Concord and Bankstown Hospitals and University of New South Wales, Sydney, NSW, Australia.
¹³ Department of Gastroenterology, Western Hospital, Melbourne, VIC, Australia.
¹⁴ Department of Gastroenterology, Royal Brisbane and Womens Hospital, and IBD Group Queensland Institute of Medical Research, University of Queensland, Brisbane, QLD, Australia.
¹⁵ AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia.

PMID: 25855073
DOI: 10.1093/ecco-jcc/jjv058

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.

Trial registration: ClinicalTrials.gov NCT00989560.

Keywords: Crohn’s disease; biologicals; health-related quality of life; inflammatory bowel disease; postoperative; smoking.

Publication types

Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adalimumab / therapeutic use
Adult
Anti-Inflammatory Agents
C-Reactive Protein / metabolism
Cecum / surgery
Colectomy
Colonoscopy
Crohn Disease / surgery*
Feces / chemistry
Female
Follow-Up Studies
Humans
Ileum / surgery
Immunosuppressive Agents / therapeutic use
Leukocyte L1 Antigen Complex / analysis
Male
Middle Aged
Prospective Studies
Quality of Life*
Recurrence
Remission Induction
Severity of Illness Index
Sex Factors
Smoking / adverse effects
Surveys and Questionnaires
Time Factors
Watchful Waiting
Young Adult

Substances

Anti-Inflammatory Agents
Immunosuppressive Agents
Leukocyte L1 Antigen Complex
C-Reactive Protein
Adalimumab

Associated data

ClinicalTrials.gov/NCT00989560