Biopsychosocial determinants of health-related quality of life after ileal pouch anal anastomosis for ulcerative colitis.
BACKGROUND
In patients with ileal pouch anal anastomosis (IPAA) the influences of psychosocial variables and of extraintestinal manifestations of ulcerative colitis (UC) on health-related quality of life (HRQOL) have not been studied so far.


METHODS
61 patients with UC (age 52.7+/-13.9 years; 47% female) completed the German version of the Inflammatory Bowel Disease Questionnaire (IBDQ-D), the Short Form Health Survey (SF - 36), the German version of the Hospital Anxiety and Depression Scale (HADS-D) and the Giessener Symptom List (GBB 24). Independent of their current clinical activity 37 patients underwent endoscopies. Pouchitis was defined by the Pouch Disease Activity Score (PDAI) > or = 7. Where possible, IPAA-patients were compared with the data for the German general population and with a clinical sample of patients with UC and no IPAA.


RESULTS
Patients with IPAA complained more about fatigue and arthralgia and a reduced physical and mental health (SF-36) than the German general population (P < 0.01). The IBDQ-total score could be predicted (adjusted R2 = 29.1, P < 0.01) by the number of operations due to IPAA-related complications (beta = -18.8) and HADS-D-Anxiety scores > or = 11 (beta = -29.1). The IBDQ-subscale score "Bowel" could be predicted (adjusted R2 = 13.7, P = 0.04) by PDAI > or = 7 (beta = -9.2) and the subscale score "Systemic" (adjusted R2 = 13.3, P = 0.04) by the number of extraintestinal manifestations (beta = -1.9).


CONCLUSIONS
HRQOL of patients with UC and IPAA is determined not only by IPAA-related factors but also by anxiety and extraintestinal manifestations with associated musculoskeletal pain.
Department of Internal Medicine I, Klinikum Saarbrücken, D-66119 Saarbrücken, Germany. w.haeuser@klinikum-saarbruecken.de
Winfried
W
Häuser
Nadine
N
Dietz
Ulf
U
Steder-Neukamm
Karl-Heinz
KH
Janke
Andreas
A
Stallmach
D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000473:pathology / Q000601:surgery*; D000714:Anastomosis, Surgical; D001007:Anxiety; D015331:Cohort Studies; D003093:Colitis, Ulcerative / Q000150:complications / Q000473:pathology / Q000601:surgery*; D039021:Colonic Pouches / Q000473:pathology*; D005221:Fatigue; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000523:psychology; D016737:Proctocolectomy, Restorative / Q000009:adverse effects* / Q000523:psychology*; D011788:Quality of Life