title: Effect of intestinal resection on quality of life in Crohn's disease.
abstract: BACKGROUND
  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.
  
  
  CONCLUSIONS
  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.
authors: Department of Gastroenterology, St Vincent's Hospital and University of Melbourne, Melbourne, VIC, Australia.
authors: Emily K
authors: EK
authors: Wright
authors: Department of Gastroenterology, St Vincent's Hospital and University of Melbourne, Melbourne, VIC, Australia mkamm@unimelb.edu.au.
authors: Michael A
authors: MA
authors: Kamm
authors: Department of Gastroenterology, St Vincent's Hospital and University of Melbourne, Melbourne, VIC, Australia.
authors: Peter
authors: P
authors: De Cruz
authors: Department of Gastroenterology, St Vincent's Hospital and University of Melbourne, Melbourne, VIC, Australia.
authors: Amy L
authors: AL
authors: Hamilton
authors: Department of Gastroenterology, St Vincent's Hospital and University of Melbourne, Melbourne, VIC, Australia.
authors: Kathryn J
authors: KJ
authors: Ritchie
authors: Department of Gastroenterology, St Vincent's Hospital and University of Melbourne, Melbourne, VIC, Australia.
authors: Efrosinia O
authors: EO
authors: Krejany
authors: Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, VIC, Australia.
authors: Alexandra
authors: A
authors: Gorelik
authors: Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, VIC, Australia.
authors: Danny
authors: D
authors: Liew
authors: Department of Gastroenterology, St Vincent's Hospital and University of Melbourne, Melbourne, VIC, Australia.
authors: Lani
authors: L
authors: Prideaux
authors: Centre for Inflammatory Bowel Diseases, Fremantle Hospital and University of Western Australia, Fremantle, WA, Australia.
authors: Ian C
authors: IC
authors: Lawrance
authors: Department of Gastroenterology and Hepatology, Royal Adelaide Hospital and University of Adelaide, Adelaide, SA, Australia.
authors: Jane M
authors: JM
authors: Andrews
authors: Department of Gastroenterology and Hepatology, Flinders Medical Centre and Flinders University, Adelaide, SA, Australia.
authors: Peter A
authors: PA
authors: Bampton
authors: Department of Gastroenterology, Alfred Health and Monash University, Melbourne, VIC, Australia.
authors: Miles P
authors: MP
authors: Sparrow
authors: Department of Gastroenterology, Mater Health Services, University of Queensland, Brisbane, QLD, Australia.
authors: Timothy H
authors: TH
authors: Florin
authors: Department of Gastroenterology, Alfred Health and Monash University, Melbourne, VIC, Australia.
authors: Peter R
authors: PR
authors: Gibson
authors: Melbourne Gastrointestinal Investigation Unit, Cabrini Hospital, Melbourne, VIC, Australia.
authors: Henry
authors: H
authors: Debinski
authors: Department of Medicine, University of Otago, Christchurch, New Zealand.
authors: Richard B
authors: RB
authors: Gearry
authors: Department of Colorectal Medicine and Genetics, and Department of Medicine, Royal Melbourne Hospital and University of Melbourne, Melbourne, VIC, Australia.
authors: Finlay A
authors: FA
authors: Macrae
authors: Gastroenterology and Liver Services, Concord and Bankstown Hospitals and University of New South Wales, Sydney, NSW, Australia.
authors: Rupert W
authors: RW
authors: Leong
authors: Department of Gastroenterology, Western Hospital, Melbourne, VIC, Australia.
authors: Ian
authors: I
authors: Kronborg
authors: Department of Gastroenterology, Royal Brisbane and Womens Hospital, and IBD Group Queensland Institute of Medical Research, University of Queensland, Brisbane, QLD, Australia.
authors: Graeme
authors: G
authors: Radford-Smith
authors: AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
authors: Warwick
authors: W
authors: Selby
authors: Department of Gastroenterology, St Vincent's Hospital and University of Melbourne, Melbourne, VIC, Australia.
authors: Michael J
authors: MJ
authors: Johnston
authors: Department of Gastroenterology, St Vincent's Hospital and University of Melbourne, Melbourne, VIC, Australia.
authors: Rodney
authors: R
authors: Woods
authors: Department of Gastroenterology, St Vincent's Hospital and University of Melbourne, Melbourne, VIC, Australia.
authors: P Ross
authors: PR
authors: Elliott
authors: Department of Gastroenterology, St Vincent's Hospital and University of Melbourne, Melbourne, VIC, Australia.
authors: Sally J
authors: SJ
authors: Bell
authors: Department of Gastroenterology, St Vincent's Hospital and University of Melbourne, Melbourne, VIC, Australia.
authors: Steven J
authors: SJ
authors: Brown
authors: Department of Gastroenterology, St Vincent's Hospital and University of Melbourne, Melbourne, VIC, Australia.
authors: William R
authors: WR
authors: Connell
authors: Department of Gastroenterology, St Vincent's Hospital and University of Melbourne, Melbourne, VIC, Australia.
authors: Paul V
authors: PV
authors: Desmond
mesh_terms: D000068879:Adalimumab / Q000627:therapeutic use; D000328:Adult; D000893:Anti-Inflammatory Agents; D002097:C-Reactive Protein / Q000378:metabolism; D002432:Cecum / Q000601:surgery; D003082:Colectomy; D003113:Colonoscopy; D003424:Crohn Disease / Q000601:surgery*; D005243:Feces / Q000737:chemistry; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007082:Ileum / Q000601:surgery; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D039841:Leukocyte L1 Antigen Complex / Q000032:analysis; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D012008:Recurrence; D012074:Remission Induction; D012720:Severity of Illness Index; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects; D011795:Surveys and Questionnaires; D013997:Time Factors; D057832:Watchful Waiting; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents; D039841:Leukocyte L1 Antigen Complex; D002097:C-Reactive Protein; D000068879:Adalimumab
keywords: Crohn’s disease; biologicals; health-related quality of life; inflammatory bowel disease; postoperative; smoking