Prospective evaluation of quality of life in patients with Zollinger-Ellison syndrome.
BACKGROUND
Zollinger-Ellison syndrome (ZES) is associated with complicated ulcer disease of the upper gastrointestinal tract. While management of ZES has dramatically improved with proton pump inhibitor therapy, quality of life in medically treated patients has not been evaluated.


METHODS
Over a 3-year period, 52 patients with ZES were prospectively evaluated at 6-month intervals with upper endoscopy and gastric acid analysis to evaluate the efficacy of current drug therapy and completion of SF36v2 forms. At each 6-month visit, patients' medication and problem lists were reviewed, comorbidities assessed, and any gastrointestinal symptoms recorded. Co-morbidity was represented as a simple illness count for the main analysis. The chronic disease score and the Charlson index were used for sensitivity analyses.


RESULTS
The unadjusted norm-based estimate of mental component score (MCS) for 52 patients with ZES (mean age 58, 65% male) was 49.8 (95% CI 46.4, 53.1). The unadjusted estimate of the physical component score (PCS) was 42.3 (95% CI 38.9, 45.7). As the number of illnesses or number of medications increased, there was a monotonic decrease in PCS scores. With multivariable adjustment, the coefficient for number of medications became non-significant. An increase in each of the co-morbidity indexes was associated with a decrease in PCS. Results did not vary by representation of co-morbidity. MCS was not significantly different from the general population.


CONCLUSIONS
Patients with medically managed ZES have norm-based estimates of the mental component scores as measured by the SF-36v2 that approximate normal values, while the physical component scores were decreased with this reduction largely explained by co-morbid illness.
Smallfield
George B
GB
Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, 703 19th Street South, Birmingham, AL 35294-0007, USA. melw@uab.edu
Allison
Jeroan
J
Wilcox
C Mel
CM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D011788:Quality of Life; D015043:Zollinger-Ellison Syndrome / Q000188:drug therapy / Q000453:epidemiology
J Gerontol A Biol Sci Med Sci. 2007 Mar;62(3):281-5
17389725
Dig Dis Sci. 2001 Nov;46(11):2416-23
11713946
J Clin Epidemiol. 2008 Dec;61(12):1234-1240
18619805
N Engl J Med. 1980 Jun 12;302(24):1344-7
6990258
Gastroenterology. 1992 Mar;102(3):767-78
1537514
Health Qual Life Outcomes. 2007 Aug 06;5:52
17683600
Ann Surg. 1955 Oct;142(4):709-23; discussion, 724-8
13259432
World J Gastroenterol. 2005 Sep 21;11(35):5423-32
16222731
BMJ. 1992 Jul 18;305(6846):160-4
1285753
Clin Gastroenterol Hepatol. 2005 Jan;3(1):39-48
15645403
J Clin Epidemiol. 1992 Feb;45(2):197-203
1573438
J Chronic Dis. 1987;40(5):373-83
3558716
Ann Surg. 2006 Sep;244(3):410-9
16926567
Med Care. 2003 May;41(5):582-92
12719681