title: Comparison of health-related quality of life and disability in ulcerative colitis patients following restorative proctocolectomy with ileal pouch-anal anastomosis versus anti-tumor necrosis factor therapy.
abstract: OBJECTIVE
  Health-related quality of life (HRQL) and disability were compared in ulcerative colitis (UC) patients who underwent restorative proctocolectomy versus patients who received treatment with anti-tumor necrosis factor (anti-TNF) agents.
  
  
  METHODS
  UC patients who underwent restorative proctocolectomy or started anti-TNF treatment between January 2010 and January 2015 were included at two tertiary referral centers. A matched cohort was created using propensity score matching for the covariates disease duration, Montreal classification, age, and sex. HRQL and disability were assessed using the Colorectal Functional Outcome (COREFO), Inflammatory Bowel Disease Disability Index (IBD-DI), EuroQol-5D-3L, and Short Form 36 (SF-36) questionnaires.
  
  
  RESULTS
  In total, 297 patients were included, of whom 205 (69%) patients responded. Fifty-nine pouch patients were matched to 59 anti-TNF-treated patients. Pouch patients reported better general health scores (P=0.042) compared with the anti-TNF group (SF-36). No differences were found for the EuroQol-5D-3L and IBD-DI between the two groups. Pouch patients had significantly higher COREFO scores compared with anti-TNF-treated patients for 'stool frequency' (P<0.001), 'antidiarrheal medication use' (P<0.001), and 'stool-related aspects' (P=0.004), of which the latter was because of a higher perianal skin irritation frequency (P<0.001).
  
  
  CONCLUSIONS
  UC patients who underwent restorative proctocolectomy reported a higher bowel movement frequency and more perianal skin irritation compared with anti-TNF-treated patients, but this did not affect overall disease-specific disability outcomes. Patients in the surgery group reported better outcomes for generic health compared with those in the anti-TNF group.
authors.affiliation: Departments of aGastroenterology and Hepatology bSurgery, Academic Medical Center, Amsterdam, The Netherlands Departments of cAbdominal Surgery dGastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
authors.forename: Sara
authors.initials: S
authors.lastname: van Gennep
authors.forename: Saloomeh
authors.initials: S
authors.lastname: Sahami
authors.forename: Christianne J
authors.initials: CJ
authors.lastname: Buskens
authors.forename: Gijs R
authors.initials: GR
authors.lastname: van den Brink
authors.forename: Cyriel Y
authors.initials: CY
authors.lastname: Ponsioen
authors.forename: André
authors.initials: A
authors.lastname: D'Hoore
authors.forename: Anthony
authors.initials: A
authors.lastname: de Buck van Overstraeten
authors.forename: Gert
authors.initials: G
authors.lastname: van Assche
authors.forename: Marc
authors.initials: M
authors.lastname: Ferrante
authors.forename: Séverine
authors.initials: S
authors.lastname: Vermeire
authors.forename: Willem A
authors.initials: WA
authors.lastname: Bemelman
authors.forename: Geert R A M
authors.initials: GR
authors.lastname: D'Haens
authors.forename: Mark
authors.initials: M
authors.lastname: Löwenberg
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001530:Belgium; D001688:Biological Products / Q000009:adverse effects / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D003093:Colitis, Ulcerative / Q000276:immunology / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D039021:Colonic Pouches / Q000009:adverse effects; D004185:Disability Evaluation; D005260:Female; D005765:Gastrointestinal Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011237:Predictive Value of Tests; D016737:Proctocolectomy, Restorative / Q000009:adverse effects; D057216:Propensity Score; D011788:Quality of Life; D020127:Recovery of Function; D012189:Retrospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000276:immunology
chemical_list: D000893:Anti-Inflammatory Agents; D001688:Biological Products; D005765:Gastrointestinal Agents; D014409:Tumor Necrosis Factor-alpha