title: Mucosal healing restores normal health and quality of life in patients with inflammatory bowel disease.
abstract: BACKGROUND
  Inflammatory bowel disease (IBD) is a debilitating immune disorder that impairs function and health-related quality of life (HRQOL). A goal of IBD treatment is mucosal healing, but it is not known whether it achieves normalization of the patients' perception of health. This can be assessed by using a cut-off scoring threshold of the Inflammatory Bowel Disease Questonnaire-36 (IBDQ-36).
  
  
  OBJECTIVE
  To determine whether patients with Crohn's disease (CD) and ulcerative colitis (UC) in clinical remission and with mucosal healing normalize their HRQOL.
  
  
  METHODS
  This is a multicentric, prospective, observational, cross-sectional study of patients who are in stable clinical remission and having mucosal healing. Patients completed the IBDQ-36, the EuroQol-5D, and the Daily Fatigue Impact Scale fatigue questionnaires. Complete restoration of health was believed to have occurred when the global score in the IBDQ-36 was at least 209 points.
  
  
  RESULTS
  A total of 115 patients (48 with CD, 67 with UC) were included. The median activity index (the Harvey-Bradshaw or the colitis activity index) was 1.0 and the median endoscopic index (Simple Endoscopic Score for Crohn's disease or Mayo) was 0. Eighty percent of the patients (79% in CD and 82% in UC patients, P=NS) normalized their HRQOL. Type of treatment was not related to normalization of HRQOL. The lack of restoration of health was significantly related to fatigue and anxiety/depression.
  
  
  CONCLUSIONS
  Mucosal healing is associated with a normalization of the perception of health by most IBD patients independently of treatment. However, a significant group of patients do not achieve restoration of HRQOL, which reinforces the necessity of a global care addressed to all patient concerns to achieve patients' complete health restoration.
authors.affiliation: Crohn-Colitis Care Unit (UACC), Networked Biomedical Research Center (Ciberehd), Vall d'Hebron University Hospital, Barcelona, Spain. fcasellas@vhebron.net
authors.forename: Francesc
authors.initials: F
authors.lastname: Casellas
authors.forename: Manuel
authors.initials: M
authors.lastname: Barreiro de Acosta
authors.forename: Marta
authors.initials: M
authors.lastname: Iglesias
authors.forename: Virginia
authors.initials: V
authors.lastname: Robles
authors.forename: Pilar
authors.initials: P
authors.lastname: Nos
authors.forename: Mariam
authors.initials: M
authors.lastname: Aguas
authors.forename: Sabino
authors.initials: S
authors.lastname: Riestra
authors.forename: Ruth
authors.initials: R
authors.lastname: de Francisco
authors.forename: Michel
authors.initials: M
authors.lastname: Papo
authors.forename: Natalia
authors.initials: N
authors.lastname: Borruel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000209:etiology; D003113:Colonoscopy; D003863:Depression / Q000209:etiology; D005221:Fatigue / Q000209:etiology; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications / Q000503:physiopathology / Q000534:rehabilitation*; D007413:Intestinal Mucosa / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011594:Psychometrics; D011788:Quality of Life; D012038:Regeneration / Q000502:physiology*; D012074:Remission Induction; D012720:Severity of Illness Index; D055815:Young Adult