title: The Impact of Endoscopic Inflammation and Mucosal Healing on Health-related Quality of Life in Ulcerative Colitis Patients.
abstract: BACKGROUND
  Health-related quality of life [HRQoL] is impaired in ulcerative colitis and is correlated to clinical disease activity. The recent shift towards more objective treatment goals like mucosal healing generates a need for evaluating the association between endoscopic disease activity, mucosal healing and HRQoL.
  
  
  METHODS
  In this cross-sectional study, patients with either active or inactive ulcerative colitis underwent sigmoidoscopy. Clinical disease activity was assessed by the Simple Clinical Colitis Activity Index [SCCAI], endoscopic inflammation by the Mayo Endoscopic Subscore [MES], and HRQoL by the Short Inflammatory Bowel Disease Questionnaire [SIBDQ] and Short Health Scale [SHS].
  
  
  RESULTS
  A total of 110 patients, 71% with active disease, had a median SCCAI score of 3 and a median MES score of 1. Patients in clinical remission had a mean SIBDQ of 60 and SHS of 6. HRQoL decreased significantly with increasing clinical (SIBDQ [χ(2) = 61.8, p < 0.0001] and SHS [χ(2) = 63.4, p < 0.0001]) and endoscopic disease activity (SIBDQ [χ(2) = 33.1, p < 0.0001] and SHS [χ(2) = 40.3, p < 0.0001]). Mucosal healing was associated with a higher HRQoL than active inflammation (59/46, p < 0.0001 [SIBDQ] and 7/20, p < 0.0001 [SHS]). Decreased HRQoL was observed with more extensive disease. Linear regression revealed strong association between SIBDQ and SHS.
  
  
  CONCLUSIONS
  Not only clinical disease activity but also endoscopic inflammation and disease extent were associated with decreased HRQoL. Patients with mucosal healing had significant higher HRQoL, emphasising the importance of this treatment goal. Both SHS and SIBDQ are easy to use and to implement, and were strongly correlated.
authors.affiliation: Gastrounit, Medical Division, Copenhagen University Hospital Hvidovre, Denmark klaus.theede@regionh.dk.
authors.forename: Klaus
authors.initials: K
authors.lastname: Theede
authors.affiliation: Gastrounit, Medical Division, Copenhagen University Hospital Hvidovre, Denmark.
authors.forename: Marianne
authors.initials: M
authors.lastname: Kiszka-Kanowitz
authors.affiliation: Gastrounit, Medical Division, Copenhagen University Hospital Hvidovre, Denmark.
authors.forename: Inge
authors.initials: I
authors.lastname: Nordgaard-Lassen
authors.affiliation: Gastrounit, Medical Division, Copenhagen University Hospital Hvidovre, Denmark.
authors.forename: Anette
authors.initials: A
authors.lastname: Mertz Nielsen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003093:Colitis, Ulcerative / Q000473:pathology* / Q000523:psychology; D003106:Colon / Q000473:pathology*; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012720:Severity of Illness Index; D012812:Sigmoidoscopy; D014945:Wound Healing
keywords: Inflammatory bowel disease; health-related quality of life; mucosal healing; patient-related outcome; ulcerative colitis