title: Relationship between diversion colitis and quality of life in rectal cancer.
abstract: OBJECTIVE
  To investigated the incidence of diversion colitis (DC) and impact of DC symptoms on quality of life (QoL) after ileostomy reversal in rectal cancer.
  
  
  METHODS
  We performed a prospective study with 30 patients who underwent low anterior resection and the creation of a temporary ileostomy for the rectal cancer between January 2008 and July 2009 at the Department of Surgery, Korea University Anam Hospital. The participants totally underwent two rounds of the examinations. At first examination, endoscopies, tissue biopsies, and questionnaire survey about the symptom were performed 3-4 mo after the ileostomy creations. At second examination, endoscopies, tissue biopsies, and questionnaire survey about the symptom and QoL were performed 5-6 mo after the ileostomy reversals. Clinicopathological data were based on the histopathological reports and clinical records of the patients.
  
  
  RESULTS
  At the first examination, all of the patients presented with inflammation, which was mild in 15 (50%) patients, moderate in 11 (36.7%) and severe in 4 (13.3%) by endoscopy and mild in 14 (46.7%) and moderate in 16 (53.3%) by histology. At the second examination, only 11 (36.7%) and 17 (56.7%) patients had mild inflammation by endoscopy and histology, respectively. There was no significant difference in DC grade between the endoscopic and the histological findings at first or second examination. The symptoms detected on the first and second questionnaires were mucous discharge in 12 (40%) and 5 (17%) patients, bloody discharge in 5 (17%) and 3 (10%) patients, abdominal pain in 4 (13%) and 2 (7%) patients and tenesmus in 9 (30%) and 5 (17%) patients, respectively. We found no correlation between the endoscopic or histological findings and the symptoms such as mucous discharge, bleeding, abdominal pain and tenesmus in both time points. Diarrhea was detected in 9 patients at the second examination; this number correlated with the severity of DC (0%, 0%, 66.7%, 33.3% vs 0%, 71.4%, 23.8%, 4.8%, P = 0.001) and the symptom-related QoL (r = -0.791, P < 0.001).
  
  
  CONCLUSIONS
  The severity of DC is related to diarrhea after an ileostomy reversal and may adversely affect QoL.
authors: Colorectal Division, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul 136-705, South Korea.
authors: Dong Nyoung
authors: DN
authors: Son
authors: Dong Jin
authors: DJ
authors: Choi
authors: Si Uk
authors: SU
authors: Woo
authors: Jin
authors: J
authors: Kim
authors: Bo Ra
authors: BR
authors: Keom
authors: Chul Hwan
authors: CH
authors: Kim
authors: Se Jin
authors: SJ
authors: Baek
authors: Seon Hahn
authors: SH
authors: Kim
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D016009:Chi-Square Distribution; D003092:Colitis / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D003113:Colonoscopy; D003967:Diarrhea / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000009:adverse effects*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011788:Quality of Life; D012004:Rectal Neoplasms / Q000453:epidemiology / Q000523:psychology / Q000601:surgery*; D012086:Reoperation / Q000009:adverse effects; D056910:Republic of Korea / Q000453:epidemiology; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
keywords: Diarrhea; Diversion colitis; Ileostomy; Quality of life; Rectal cancer
references: Gastroenterology. 1981 Mar;80(3):438-41
references: 7450438
references: Br J Surg. 2003 Aug;90(8):999-1003
references: 12905555
references: Dis Colon Rectum. 1993 Apr;36(4):366-7
references: 8458263
references: Hum Pathol. 1993 Feb;24(2):211-9
references: 8432517
references: J Pediatr Gastroenterol Nutr. 1997 Sep;25(3):273-80
references: 9285377
references: Hum Pathol. 1990 Apr;21(4):429-36
references: 2318485
references: Br J Surg. 1996 Jan;83(1):60-2
references: 8653367
references: N Engl J Med. 1989 Jan 5;320(1):23-8
references: 2909876
references: Surgery. 2003 Jan;133(1):56-65
references: 12563238
references: Br J Surg. 2010 Aug;97(8):1295-303
references: 20602501
references: Am J Gastroenterol. 1990 Jul;85(7):850-4
references: 2371986
references: Gut. 1993 Mar;34(3):382-5
references: 8472988
references: Int J Radiat Oncol Biol Phys. 2010 Mar 15;76(4):1005-11
references: 19540058
references: Dis Colon Rectum. 1998 May;41(5):543-9; discussion 549-51
references: 9593234
references: Dig Dis Sci. 1997 Dec;42(12):2577-80
references: 9440640
references: Br J Surg. 1998 Aug;85(8):1036-43
references: 9717993
references: JAMA. 1990 Sep 19;264(11):1444-50
references: 2202842
references: Scand J Gastroenterol. 2001 Jul;36(7):744-50
references: 11444474
references: Am Surg. 1991 Jan;57(1):46-9
references: 1796797
references: Surg Endosc. 1994 Jan;8(1):19-24
references: 8153859
references: Cancer Invest. 1995;13(1):1-7
references: 7834464
references: Gastroenterology. 1987 Dec;93(6):1404-8
references: 3678755
references: Br J Surg. 2006 Dec;93(12):1519-25
references: 17054311
references: Gut. 2003 Jul;52 Suppl 5:v1-15
references: 12801941
references: World J Surg. 2002 Nov;26(11):1354-9
references: 12297930
references: Ann Surg. 2012 May;255(5):922-8
references: 22504191