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P438 The inflammatory bowel disease disability index applied to ileal pouch anal anastomoses in New Zealand

Y. Lee1, A. McCombie*1, 2, R. Gearry3, F. Frizelle1, J. Williman4, R. Leong5, T. Eglinton1

1University of Otago, Department of Surgery, Christchurch, New Zealand, 2University of Otago, Department of Medicine, Dunedin, New Zealand, 3University of Otago, Department of Medicine, Christchurch, New Zealand, 4University of Otago, Christchurch, Department of Population Health, Christchurch, New Zealand, 5University of New South Wales, Medicine, Sydney, Australia

Background

The inflammatory bowel disease (IBD) disability index (IDI), which measures IBD associated disability, has previously been validated on IBD patients1 but is yet to be validated on ileal pouch anal anastomosis (IPAA) recipients. This study aims to validate the IDI versus the IBD Questionnaire (IBDQ),2 which measures quality of life (QoL), on IPAA recipients. It is hypothesised the IDI will be highly valid as a measure of IBD associated disability.

Methods

A population-based cohort of IPAA recipients from Canterbury, New Zealand, were recruited for this study. Their demographic, indication, and complication data were collected via their medical records whilst their disability and QoL were measured using the IDI and IBDQ, respectively. The ulcerative colitis (UC) indicated IPAAs from this cohort were also compared with medically managed UC patients without an IPAA from an Australian cohort1 in terms of IDI and IBDQ scores.

Results

In total, 136 IPAAs were found dating from 1984–2013 (Figure 1). Of these, 84 completed the IDI (Table 1) and 80 completed the IBDQ. There was a high association between the IBDQ and IDI (r = 0.84, p < 0.01) (Figure 2). IBDQ and IDI had many common predictors: those with their position affected at work, who had > 100 days off work in the last year, who had Crohn’s disease (vs UC), and with early Grade 3 or 4 Clavien–Dindo complications had both worse disability and poorer QoL (Table 2). This study’s cohort had higher IDI scores (indicating less disability) than the Australian UC cohort (-0.49 vs -6.39, p = 0.04); IBDQ scores did not differ between the 2 groups, however.

Figure 1. Participant identification and recruitment.

Figure 2. The correlation between the inflammatory bowel disease questionnaire and inflammatory bowel disease disability index.

Table 1 Participant demographics, indications, and complications

Participant characteristics (n = 84)Frequency (%) or mean (standard deviation)
Male sex47 (56%)
New Zealand European ethnicity70 (83.3%)
Average age51.5 (12.8)
Average number of years since surgery11.5 (6.0)
Ulcerative colitis67 (79.8%)
Crohn’s disease8 (9.5%)
Indication emergency colectomy12 (14.3%)
Any early complications20 (24.1%)
Any late complications65 (77.4%)

Table 2 Significant differences in IDI and BDQ

VariableMore disability 
(lower IDI)Lower quality of life (lower IBDQ)
Older (> 40) age at surgeryp < 0.05not significant
Position at work affect by bowelp < 0.01p < 0.01
➣ 100 days off work in the 
last yearp < 0.05p < 0.05
Any early complicationsnot significantp < 0.05
Grade 3 or 4 Clavien–Dindo 
complications before surgeryp < 0.01p < 0.01
Having Crohn’s diseasep < 0.05p < 0.05
Indication failed medical therapy 
(vs familial adenomatous polyposis [FAP] prophylaxis)p < 0.05not significant
Early small bowel obstructionnot significantp < 0.05
Femalenot significantp < 0.05

Conclusion

The IDI has been validated in an IPAA cohort. IDI and IBDQ measure similar, but not identical constructs.

References:

[1] Leong R, Huang T, Ko Y, et al. Prospective validation study of the International Classification of Functioning, Disability and Health score in Crohn’s disease and ulcerative colitis. J Crohns Colitis 2014;8(10):1237–45.

[2] Irvine EJ, Feagan B, Rochon J, et al. Quality of life: a valid and reliable measure of therapeutic efficacy in the treatment of inflammatory bowel disease. Canadian Crohn’s Relapse Prevention Trial Study Group, Gastroenterol 1994;106(2):287–96.