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P300. Quality of life in Crohn's disease patients with endoscopic recurrence after surgery: Influence of thiopurine treatment

G. Bastida, M. Aguas, B. Beltrán, M. Iborra, I. Moret, F. Rausell, P. Nos

La Fe Hospital, Valencia, Spain

Introduction: Crohn's disease (CD) impacts negatively upon health-related quality of life (HRQL). Near 70% of CD patients require a surgical resection. Postoperative recurrence is a significant problem in the management of CD. Endoscopic recurrence is an early event since there is a progression of endoscopic lesions. Thiopurines are the most common drugs used to prevent the progression of recurrence.

Objectives: To analyze the HRQL in CD patients with endoscopic recurrence, to assess the influence of treatment with thiopurines on HRQL and to evaluate the influence of mucosal healing on different dimensions of HRQL.

Methods: All CD patients who underwent a surgical resection were endoscopically evaluated after 12 months. Recurrence in the neoterminal ileum was defined by a Rutgeerts score ≥1. In case of recurrence patients started with Azathioprine 2.5 mg/Kg. Patients were evaluated at baseline and then after 6 and 12 months, measures of disease activity (CDAI), HRQL and endoscopic data were collected. Patients were considered in remission if CDAI < 150 and mucosal healing were considered if Rutgeerts score = 0. HRQL was assessed using a generic (SF-36) and specific (IBDQ) questionnaires. Twenty one consecutive patients were included [11 (52%) males, median age 37 years].

Results: At baseline patients scored worse than Spanish general population in all 8 dimensions of SF-36. Basal IBDQ score was (5.0) and showed an impairment of the five dimensions compared with IBD inactive patients. After six months, 18/21 (86%) patients were in clinical remission. Patients showed an improvement in overall IBDQ score (5.41) and also in all IBDQ and SF-36 dimensions (without statistical significance). Eight patients accepted a colonoscopy, 3 (37.5%) had mucosal healing. HRQL was independent of endoscopic lesions. Sixteen patients achieved 12 months of follow up, 15 (94%) in clinical remission. IBDQ score (5.7) and all dimensions of IBDQ improved from baseline, with statistical significance in bowel symptoms, social impairment and emotional function. All dimensions of SF-36 scored higher than baseline and make them similar to Spanish general population, with statistical significance in physical functioning, role physical, bodily pain, general health, vitality, social functioning and mental health. Twelve of 16 patients underwent a colonoscopy, 6/12 (50%) achieved mucosal healing. Improvement in HRQL was independent of mucosal healing.

Conclusions: CD patients with endoscopic recurrence have an impaired perception of HRQL. Azathioprine could have a positive effect on HRQL although the absence of relationship with mucosal healing does not support this fact.