Vnitr Lek 2018, 64(4):347-354 | DOI: 10.36290/vnl.2018.052

Impact of surgery on quality of life in Crohn's disease patients: final results of Czech cohort

Lumir Kunovsky1,2,*, Ladislav Mitas1, Filip Marek1, Jiri Dolina2, Karolina Poredska2, Lenka Kucerova2, Klara Benesova3,4, Zdenek Kala1
1 Department of Surgery, University Hospital Brno, Medicine of adult age (Bohunice), and Faculty of Medicine, Masaryk University, Brno, Czech Republic
2 Department of Gastroenterology, University Hospital Brno, Medicine of adult age (Bohunice), and Faculty of Medicine, Masaryk University, Brno, Czech Republic
3 Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
4 Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic

Introduction:
Crohn's disease (CD) belongs to chronic diseases that highly affect the patient's quality of life (QoL). The effect of the disease and impairment of QoL in CD patients is already known. The aim was to assess how surgical treatment influences the patients' QoL and determine factors that can affect postoperative QoL.


Methods and patients:
We compared the QoL before and after surgery in patients who had undergone a bowel resection at our department due to CD between 2010-2016. The patients filled in a standardized QLQ-CR29 questionnaire to assess QoL in the preoperative period and the postoperative period after a 2-month interval. The control groups were CD patients who had not undergone surgical treatment (bowel resection) and a healthy cohort. In the QoL evaluation, 132 patients with CD who had undergone surgery (bowel resection), 83 patients with CD without an operation and 104 healthy subjects were enrolled.

Results:
104 of the operated patients experienced a postoperative improvement of the overall QoL (78.8 %), 2 patients did not register any changes in QoL (1.5 %) and 26 patients (19.7 %) experienced a worsening of their postoperative QoL. The results were statistically significant (p < 0.001).

Conclusion:
We detected a significant improvement of the overall QoL after surgical resection in CD patients (measured 2 months after surgery). Gender was identified as the only statistically relevant factor with influence on postoperative QoL.

Keywords: bowel resection; Crohn's disease; Czech cohort; inflammatory bowel disease; quality of life; surgical treatment

Received: October 15, 2017; Accepted: January 12, 2018; Published: April 1, 2018  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Kunovsky L, Mitas L, Marek F, Dolina J, Poredska K, Kucerova L, et al.. Impact of surgery on quality of life in Crohn's disease patients: final results of Czech cohort. Vnitr Lek. 2018;64(4):347-354. doi: 10.36290/vnl.2018.052.
Download citation

References

  1. Burisch J, Weimers P, Pedersen N et al. Health-related quality of life improves during one year of medical and surgical treatment in a European population-based inception cohort of patients with Inflammatory Bowel Disease - An ECCO-EpiCom study. J Crohns Colitis 2014; 8(9): 1030-1042. Dostupné z DOI: <http://dx.doi.org/10.1016/j.crohns.2014.01.028>. Go to original source... Go to PubMed...
  2. Moradkhani A, Beckman LJ, Tabibian JH. Health-related quality of life in inflammatory bowel disease: Psychosocial, clinical, socioeconomic, and demographic predictors. J Crohns Colitis 2013; 7(6): 467-473. Dostupné z DOI: <http://dx.doi.org/10.1016/j.crohns.2012.07.012>. Go to original source... Go to PubMed...
  3. Umanskiy K, Fichera A. Health related quality of life in inflammatory bowel disease: The impact of surgical therapy. World J Gastroenterol 2010; 16(40): 5024-5034. Go to original source... Go to PubMed...
  4. Kunovsky L, Hemmelova B, Kala Z et al. Crohn disease and pregnancy: a case report of an acute abdomen. Int J Colorectal Dis 2016; 31(8): 1493-1494. Dostupné z DOI: <http://dx.doi.org/10.1007/s00384-016-2554-1>. Go to original source... Go to PubMed...
  5. Mikocka-Walus AA, Turnbull DA, Andrews JM et al. Psychological problems in gastroenterology outpatients: A South Australian experience. Psychological co-morbidity in IBD, IBS and hepatitis C. Clin Pract Epidemiol Ment Health 2008; 4: 15. Dostupné z DOI: <http://dx.doi.org/10.1186/1745-0179-4-15>. Go to original source... Go to PubMed...
  6. Gavrilescu O, Mihai C, Anton-Paduraru DT et al. Impact of Inflammatory Bowel Diseases on Quality of Life. Revista de Cercetare si Interventie Sociala 2015; 50: 80-95.
  7. Herrera-deGuise C, Casellas F, Robles V et al. Predictive value of early restoration of quality of life in Crohn's disease patients receiving antitumor necrosis factor agents. J Gastroenterol Hepatol 2015; 30(2): 286-291. Dostupné z DOI: <http://dx.doi.org/10.1111/jgh.12803>. Go to original source... Go to PubMed...
  8. Riss S, Schwameis K, Mittlböck M et al. Sexual function and quality of life after surgical treatment for anal fistulas in Crohn's disease. Tech Coloproctol 2013; 17(1): 89-94. Dostupné z DOI: <http://dx.doi.org/10.1007/s10151-012-0890-x>. Go to original source... Go to PubMed...
  9. Iglesias-Rey M, Barreiro-de Acosta M, Caamaño-isorna F et al. Psychological Factors Are Associated with Changes in the Health-related Quality of Life in Inflammatory Bowel Disease. Inflamm Bowel Dis 2014; 20(1): 92-102. Dostupné z DOI: <http://dx.doi.org/10.1097/01.MIB.0000436955.78220.bc>. Go to original source... Go to PubMed...
  10. Lix L, Graff L, Walker J et al. Longitudinal Study of Quality of Life and Psychological Functioning for Active, Fluctuating, and Inactive Disease Patterns in Inflammatory Bowel Disease. Inflamm Bowel Dis 2008; 14(11): 1575-1584. Dostupné z DOI: <http://dx.doi.org/10.1002/ibd.20511>. Go to original source... Go to PubMed...
  11. Casellas F, López-Vivancos J, Badia X et al. Impact of surgery for Crohn's disease on health-related quality of life. Am J Gastroenterol 2000; 95(1): 177-182. Dostupné z DOI: <http://dx.doi.org/10.1111/j.1572-0241.2000.01681.x>. Go to original source... Go to PubMed...
  12. Cohen RD. The quality of life in patients with Crohn's disease. Aliment Pharmacol Ther 2002; 16(9): 1603-1609. Go to original source... Go to PubMed...
  13. Aratari A, Papi C, Leandro G et al. Early versus late surgery for ileo-caecal Crohn's disease. Aliment Pharmacol Ther 2007; 26(10): 1303-1312. Dostupné z DOI: <http://dx.doi.org/10.1111/j.1365-2036.2007.03515.x>. Go to original source... Go to PubMed...
  14. De Cruz P, Kamm MA, Hamilton AL et al. Crohn's disease management after intestinal resection: a randomised trial. Lancet 2015; 385(9976): 1406-1417. Dostupné z DOI: <http://dx.doi.org/10.1016/S0140-6736(14)61908-5>. Go to original source... Go to PubMed...
  15. Bernell O, Lapidus A, Hellers G. Risk factors for surgery and postoperative recurrence in Crohn's disease. Ann Surg 2000; 231(1): 38-45. Go to original source... Go to PubMed...
  16. Bobanga I, Bai S, Swanson M et al. Factors influencing disease recurrence after ileocolic resection in adult and pediatric onset Crohn's disease. Am J Surg 2014; 208(4): 591-596. Dostupné z DOI: <http://dx.doi.org/10.1016/j.amjsurg.2014.06.008>. Go to original source... Go to PubMed...
  17. Fornaro R, Caratto E, Caratto M et al. Post-operative recurrence in Crohn's disease. Critical analysis of potential risk factors. An update. Surgeon 2015; 13(6): 330-347. Dostupné z DOI: <http://dx.doi.org/10.1016/j.surge.2015.04.002>. Go to original source... Go to PubMed...
  18. Kala Z, Marek F, Válek V et al. Crohn's disease surgery. Vnitř Lék 2014; 60(7-8): 617-623. Go to PubMed...
  19. Kunovsky L, Kala Z, Mitas L et al. Quality of life after bowel resection for Crohn's disease - first results. Rozhl Chir 2016; 95(12): 444-448. Go to PubMed...
  20. Whistance RN, Conroy T, Chie W et al. Clinical and psychometric validation of the EORTC QLQ-CR29 questionnaire module to assess health-related quality of life in patients with colorectal cancer. Eur J Cancer 2009; 45(17): 3017-3026. Dostupné z DOI: <http://dx.doi.org/10.1016/j.ejca.2009.08.014>. Go to original source... Go to PubMed...
  21. Gujral S, Conroy T, Fleissner C et al. Assessing quality of life in patients with colorectal cancer: An update of the EORTC quality of life questionnaire. Eur J Cancer 2007; 43(10): 1564-1573. Dostupné z DOI: <http://dx.doi.org/10.1016/j.ejca.2007.04.005>. Go to original source... Go to PubMed...
  22. Bewtra M, Su C, Lewis JD. Trends in Hospitalization Rates for Inflammatory Bowel Disease in the United States. Clin Gastroenterol Hepatol 2007; 5(5): 597-601. Dostupné z DOI: <http://dx.doi.org/10.1016/j.cgh.2007.01.015>. Go to original source... Go to PubMed...
  23. de Buck van Overstraeten A, Wolthuis A, D'Hoore A. Surgery for Crohn's disease in the era of biologicals: A reduced need or delayed verdict? World J Gastroenterol 2012; 18(29): 3828-3832. Dostupné z DOI: <http://dx.doi.org/10.3748/wjg.v18.i29.3828>. Go to original source... Go to PubMed...
  24. Ferrari L, Krane MK, Fichera A. Inflammatory bowel disease surgery in the biologic era. World J Gastrointest Surg 2016; 8(5): 363-370. Dostupné z DOI: <http://dx.doi.org/10.4240/wjgs.v8.i5.363>. Go to original source... Go to PubMed...
  25. Delaney CP, Kiran RP, Senagore AJ et al. Quality of life improves within 30 days of surgery for Crohn's disease. J Am Coll Surg 2003; 196(5): 714-721. Dostupné z DOI: <http://dx.doi.org/10.1016/S1072-7515(03)00131-5>. Go to original source... Go to PubMed...
  26. Yazdanpanah Y, Klein O, Gambiez L et al. Impact of surgery on quality of life in Crohn's disease. Am J Gastroenterol 1997; 92(10): 1897-1900.
  27. Thirlby RC, Land JC, Fenster LF et al. Effect of Surgery on Health-Related Quality of Life in Patients With Inflammatory Bowel Disease: A Prospective Study. Arch Surg 1998; 133(8): 826-832. Go to original source... Go to PubMed...
  28. Bączyk G, Formanowicz D, Gmerek Ł et al. Health-related quality of life assessment among patients with inflammatory bowel diseases after surgery - review. Gastroenterology Rev 2017; 12(1): 6-16. Dostupné z DOI: <http://dx.doi.org/10.5114/pg.2016.64037>. Go to original source... Go to PubMed...
  29. Achkar JP, Hanauer SB. Medical therapy to reduce postoperative Crohn's disease recurrence. Am J Gastroenterol 2000; 95(5): 1139-1146. Dostupné z DOI: <http://dx.doi.org/10.1111/j.1572-0241.2000.02000.x>. Go to original source... Go to PubMed...
  30. Tabibian A, Tabibian JH, Beckman LJ et al. Predictors of health-related quality of life and adherence in Crohn's disease and ulcerative colitis: implications for clinical management. Dig Dis Sci 2015; 60(5): 1366-1374. Dostupné z DOI: <http://dx.doi.org/10.1007/s10620-014-3471-1>. Go to original source... Go to PubMed...
  31. Stjernman H, Tysk C, Almer S et al. Worries and concerns in a large unselected cohort of patients with Crohn's disease. Scand J Gastroenterol 2010; 45(6): 696-706. Dostupné z DOI: <http://dx.doi.org/10.3109/00365521003734141>. Go to original source... Go to PubMed...
  32. Magalhães J, Castro FD de, Carvalho PB et al. Quality of life in patients with inflammatory bowel disease: importance of clinical, demographic and psychosocial factors. Arq Gastroenterol 2014; 51(3): 192-197. Go to original source... Go to PubMed...
  33. Zheng K, Zhang S, Wang C et al. Health-Related Quality of Life in Chinese Patients with Mild and Moderately Active Ulcerative Colitis. PLoS ONE 2015; 10(4): e0124211. Dostupné z DOI: <http://dx.doi.org/10.1371/journal.pone.0124211>. Go to original source... Go to PubMed...
  34. Kunovský L, Marek F, Kala Z et al. Possibilities of minimally invasive surgery in patients with Crohn's disease and ulcerative colitis. Gastroenterol Hepatol 2017; 71(1): 29-35. Go to original source...
  35. Thaler K, Dinnewitzer A, Oberwalder M et al. Assessment of long-term quality of life after laparoscopic and open surgery for Crohn's disease. Colorectal Dis 2005; 7(4): 375-381. Dostupné z DOI: <http://dx.doi.org/10.1111/j.1463-1318.2005.00769.x>. Go to original source... Go to PubMed...
  36. Scarpa M, Ruffolo C, Bassi D et al. Intestinal surgery for Crohn's disease: Predictors of recovery, quality of life, and costs. J Gastrointest Surg 2009; 13(12): 2128-2135. Dostupné z DOI: <http://dx.doi.org/10.1007/s11605-009-1044-y>. Go to original source... Go to PubMed...




Vnitřní lékařství

Madam, Sir,
please be aware that the website on which you intend to enter, not the general public because it contains technical information about medicines, including advertisements relating to medicinal products. This information and communication professionals are solely under §2 of the Act n.40/1995 Coll. Is active persons authorized to prescribe or supply (hereinafter expert).
Take note that if you are not an expert, you run the risk of danger to their health or the health of other persons, if you the obtained information improperly understood or interpreted, and especially advertising which may be part of this site, or whether you used it for self-diagnosis or medical treatment, whether in relation to each other in person or in relation to others.

I declare:

  1. that I have met the above instruction
  2. I'm an expert within the meaning of the Act n.40/1995 Coll. the regulation of advertising, as amended, and I am aware of the risks that would be a person other than the expert input to these sites exhibited


No

Yes

If your statement is not true, please be aware
that brings the risk of danger to their health or the health of others.