P201 Disability and health-related quality of life in patients with moderate-severe ulcerative colitis: impact of restorative proctocolectomy versus medical treatment with anti-tumour necrosis factor agents
S. van Gennep*1, S. Sahami1, W. Bemelman2, C. Buskens2, A. D’Hoore3, A. de Buck van Overstraeten3, M. Ferrante4, S. Vermeire4, G. D’Haens1, M. Löwenberg1
1Academic Medical Centre (AMC), Department of Gastroenterology and Hepatology, Amsterdam, Netherlands, 2Academic Medical Centre (AMC), Department of Surgery, Amsterdam, Netherlands, 3UZ Leuven, Campus Gasthuisberg, Department of Surgery, Leuven, Belgium, 4UZ Leuven, Campus Gasthuisberg, Department of Gastroenterology and Hepatology, Leuven, Belgium
Restorative proctocolectomy (RPC) with ileal pouch-anal anastomosis (IPAA) and medical treatment with anti-tumour necrosis factor (TNF) agents are both effective in the management of moderate-to-severe ulcerative colitis (UC). However, surgery is often considered less expensive. We compared health-related quality of life (HRQL) and disability in UC patients who underwent RPC with IPAA versus patients who receive(d) anti-TNF treatment, including patients with less favourable outcomes.
Patient cohorts from 2 tertiary IBD referral centres were studied. Patients with moderate-to-severe UC who started anti-TNF treatment or who underwent RPC with IPAA between January 1, 2010, and January 1, 2015, were included. Patients with postoperative complications or pouch failure were also included in the surgical group. In the medical group, patients had received at least anti-TNF induction treatment (infliximab, adalimumab, or golimumab). Patients with loss of response or adverse events to anti-TNF agents were included, as well. Patients were approached by (e-)mail and were invited to complete the questionnaires. A matched cohort was created out of the response patients using propensity score matching for the covariates disease duration, extent of disease, age, and gender. Differences in generic HRQL and disability (EQ-5D-3L and SF-36 questionnaires), and disease-specific quality of life and disability (COREFO and IBD Disability Index questionnaires) were analysed in the matched cohort.
In total, 300 patients were included, and 177 patients (59.3%) responded at the time of this analysis. The matched cohort consisted of 51 patients in each group. In the medical group, 34 patients (64.7%) received anti-tumour necrosis factor (TNF) maintenance treatment (mean treatment duration: 38.3 ± 18.7 months), and 18 patients (35.3%) stopped anti-TNF treatment (median treatment duration 7 months [3–14]). In the surgical group, all patients had a functional pouch for a mean duration of 34.5 ± 16.6 months. Surgical patients reported more problems with overall pain or discomfort (p = 0.046) and stool related aspects (p = 0.004), and had higher scores for stool frequency (p < 0.001), anti-diarrheal medication use (p < 0.001), and IBD disability index (p = 0.026). No significant differences in SF-36 outcomes were found.
Patients in the surgical group had significantly higher disease-specific disability scores compared with patients in the medical group, indicating more bowel-related problems. Anatomical changes because of surgery seem to be responsible for the observed differences regarding loose stools and increased bowel movements. However, no differences were found in generic HRQL and disability between the 2 groups.