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P294. Does medical or surgical option influence quality of life in UC patients with a previous severe flare?

F. Portela1, F. Magro2, P. Ministro3, J. de Deus4, M. Cravo5, J. Cotter6, G. Duque1, F. Ferreira2, B. Rosa6, P.L. Ferreira7

1Hospital da Universidade de Coimbra and GEDII, Coimbra, Portugal; 2Hospital de S. João and GEDII, Porto, Portugal; 3Hospital de S. Teotónio and GEDII, Viseu, Portugal; 4Hospital Fernando Fonseca and GEDII, Amadora, Portugal; 5IPO Lisboa and GEDII, Lisboa, Portugal; 6Centro Hospitalar do Alto Ave and GEDII, Guimarães, Portugal; 7Faculdade de Economia da Universidade de Coimbra, Coimbra, Portugal

Introduction: In ulcerative colitis (UC) surgery is indicated in patients with symptoms refractory to medical therapy and is considered to improve quality of life (QOL) in most studies. However the comparison is mostly done with the pre-surgical condition and not with a proper control group.

Aim: To compare QOL of patients with a severe flare and characterized by a steroids resistant or dependent course submitted to surgery (Surg) or treated successfully with immunosuppressants (IS).

Methods: Patients were identified in the data base of the Portuguese IBD Study Group and attending physicians were invited to contact them in order to participate in the study. QOL analyses were done using the Inflammatory Bowel Disease Questionnaire (IBDQ), and the SF 36 with additional questions regarding health care utilization and medication use answered by the physician.

Results: In total 159 patients were included, 70 submitted to surgery, 78 males, age 43.5±14. The median follow up (similar in both groups) since diagnosis and surgery/immunosuppression was 9.9±6.9 and 5±3.2 years.

The IBDQ is Surg = 169.6±34.7, IS = 175.8±28.8 (p, NS).

The SF-36 showed similar scores in seven of the eight scales and a better score for Physical Activity in the group treated with immunosuppressants (p = 0.017).

The surgical patients reported fewer visits to their specialist (p < 0.001) and a similar mean number and rate of hospitalizations (Surg 2.2; IS 2.3; p NS).

In the Immunosuppressants group 14 (16%) used Steroids and Cyclosporin, 18 (20%) Steroids and Infliximab and 57 (64%) Steroids and initiated azathioprine as maintenance. During the follow up 54 were kept on azathioprine, 24 maintained or initiate Infliximab and 11 ultimately stop all immunosuppressive therapy.

In the surgical group although most patients were without medication or reported only sporadic use of 5ASA or antibiotics (70%) there are 5.7% who need immunosuppressors and 24% used steroids at least once.

Conclusions: Quality of life can be considered normal in most patients and is similar in patients submitted to surgery or kept under immunosuppression with the latest showing a better score for physical activity in SF36.