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P090. Restoration of health in patients with inflammatory bowel disease and mucosal healing


F. Casellas Jorda1, M. Barreiro-de Acosta2, M. Iglesias2, V. Robles1, P. Nos3, M. Aguas4, S. Riestra5, R. De Francisco5, M. Papo6, N. Borruel1

1Hospital Vall D'Hebron, Barcelona, Spain; 2University Hospital, Santiago De Compostela, Spain; 3La Fe Hospital, Instituto De Investigacion Sanitaria, Valencia, Spain; 4La Fe Hospital, Valencia, Spain; 5Hospital Universitario Central De Asturias, Inflammatory Bowel Disease Unit, Oviedo, Spain; 6Hospital Joan XXIII, Tarragona, Spain



Background: Inflammatory bowel disease (IBD) impairs health and its related quality of life (HRQOL). At present, IBD treatment goals include healing of mucosal lesions. An even more ambitious goal of treatment is to achieve the patient's normalization of health. This can be assessed by using a cut-off scoring threshold of the IBDQ-36 questionnaire. It has not been established whether mucosal healing is able to restore to normal patient's HRQOL.

Aims: To determine whether patients with Crohn's disease (CD) and ulcerative colitis (UC) in clinical remission and mucosal healing achieve the normalization of their HRQOL.

Methods: Prospective, multicentric, observational and cross-sectional study in patients with stable complete clinical remission, normal CRP and endoscopic mucosal healing. Patients completed the specific questionnaire IBDQ-36, the generic EQ-5D and the fatigue questionnaire EIDF. Complete restoration of health was considered when overall score of IBDQ-36 was ≥209 points (J Crohns Colitis. 2010;4:637).

Results: 115 patients (48 with CD and 67 with UC) were included. Treatment with salicylates was more frequent in UC (62 vs 10%, p < 0.001) and antiTNFα agents were more frequent in CD (57% vs 7%, p < 0.001). Twelve patients (10%) received no treatment. Median activity index (HB or CAI) was 1.0, median endoscopic index (SES-CD or Mayo) was 0 and median ESR 8 mm/h. Median global IBDQ-36 was 229 in CD and 230 in UC. Global and the five dimensions of IBDQ-36 were not different between CD and UC. HRQOL normalized in 80% of patients (79% in CD and 82 in UC patients, p = ns). Type of treatment was not related with normalization of HRQOL. Lack of restoration of health was significantly associated with fatigue and problems related with anxiety/depression (that were absent in almost all patients who restored HRQOL but were referred as moderate/severe by 63% by patients who do not restore perception of health).

Conclusions: Most IBD patients in clinical remission and mucosal healing normalize their perception of health independently of treatment. However, a significant group of patients do not restore quality of life. That reinforces the necessity of a global care addressed to all patient concerns to achieve their complete health restoration.