P251. Outcomes of bowel function and quality of life in paediatric patients with Crohn's disease operated in their childhood
M. Piekkala1, M. Pakarinen1, M. Ashorn2, R. Rintala1, K.‑L. Kolho1
1Helsinki University Central Hospital and Helsinki University, Children's hospital, Helsinki, Finland; 2Tampere University Hospital, Department of Pediatrics, Tampere, Finland
Background: Of the children with Crohn's disease (CD) 20–30% undergo surgery within 10 years. Surgery does not cure the disease and relapses are common. Long-term outcomes of surgery for paediatric onset CD are unclear.
Methods: We reviewed in 2010 the hospital records of all paediatric CD patients operated on during 1985–2008 in the two tertiary care hospitals in Finland covering 56% of the total child population. Questionnaires on bowel function, health-outcomes and quality of life (Qol) were mailed to patients. Qol was measured with a visual analogue scale (scores 1–7) with four generic questions assessing 3 different dimensions of Qol (physical, emotional, and social functioning) and overall Qol, and compared to matched control children randomly chosen from Population Register Centre.
Results: 38 patients with paediatric onset CD had undergone surgery at a median of 9 years earlier (range 2–21 years).
| Operations | No. patients (38) | % |
|---|---|---|
| Colectomy | 7 | 18 |
| Proctocolectomy* | 4 | 10 |
| Colon resection | 12 | 30 |
| Ileocecal resection | 9 | 23 |
| Ileal resection | 7 | 18 |
| Ostomy | 1 | 3 |
Disease had endoscopically relapsed in all (100%) patients by 5.5 years of follow-up. At least one surgical complication had occurred in 79% patients and 61% had undergone re-operation. The number of complications and re-operations was statistically higher in patients followed more than ten years. By the study end-point, the disease was active in 72%.
68% of the patients responded to questionnaire and reported a median stool frequency 4 for day and 0 for night. There was no difference in bowel function between different operation types. Soiling occurred less often than 3 times per week in all patients and 40% were totally continent. Qol did not differ between patients and controls or between different operation types. The overall Qol was statistically lower in patients (32%) who had missed school or work because of the disease and those who reported soiling (60%).
Conclusions: The disease relapse rate is high in patients with paediatric onset Crohn's disease after surgery. Most patients have experienced at least one complication after surgery. Reassuring the Qol is comparable between patients and controls within the first decade after surgery.