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P567 Functional outcomes and factors influencing quality of life in patients with ulcerative colitis after total proctocolectomy with ileal pouch anal anastomosis

K. Watanabe*, M. Nagao, T. Abe, H. Karasawa, S. Ohnuma, H. Musha, T. Naitoh, M. Unno

Tohoku University Graduate School of Medicine, Department of Surgery, Sendai, Japan

Background

Total proctocolectomy with ileal pouch anal anastomosis (IPAA) has been established as the standard surgical treatment for patients with ulcerative colitis (UC). However, new problems such as an increasing frequency of bowel movements develop after surgery. The aim of the present study was to assess the function outcomes and factors influencing quality of life (QoL) in patients with UC after IPAA by questionnaire survey.

Methods

Two questionnaires, Questionnaire on Bowel Function (QBF), Inflammatory Bowel Disease Questionnaire (Japanese IBDQ), were sent to 121 patients with UC who underwent staged IPAA in Tohoku University Hospital. We regarded question 23 in the QBF, which ascertained the daily life satisfaction score (DLSS), as a patient’s sense of subjective well-being. The DLSS indicates the patient’s response to the question ‘How do you feel about your daily life at present?’ Possible responses are ‘completely satisfied’, ‘well satisfied’, ‘not so satisfied’, or ‘not satisfied’, respectively. Functional outcomes and factors influencing DLSS after IPAA were assessed.

Results

In total, 79 patients (65%) responded (age at questionnaire; 35 years [16–70] [median, range], length since stoma closure; 2.3 years [0.21–3.2]). The number of daily bowel movements moderately correlated with postoperative time after stoma closure (Spearman’s ρ = -0.397, p < 0.001). The median number of daily bowel movements in terms of postoperative periods after stoma closure was 9 times (≤ 1 year, n = 19), 7 times (1–5 years, n = 39), and 5.5 times (> 5 years, n = 21), respectively. The ratio of patients who usually had bowel movements after bedtime also mildly correlated with postoperative time after stoma closure (68% (≤ 1 year), 41% (1–5years), 33% (> 5 years). Spearman’s ρ = -0.275, p = 0.009). The response of DLSS was as follows; ‘completely satisfied’, 17%; ‘well satisfied’, 67%; ‘not so satisfied’, 11%; and ‘not satisfied’, 5%. To test the discriminative validity of DLSS, we calculated Pearson’s correlation coefficient to assess the relationship between DLSS and the Japanese IBDQ. We found moderate to high correlations between DLSS and the IBDQ domains (r = 0.400 to 0.633, p < 0.001). The median total IBDQ score in terms of DLSS was 188 (completely satisfied), 181 (well satisfied), 132 (not so satisfied), and 114 (not satisfied), respectively. Multivariate analysis showed that ‘trip activity’, ‘care about where the restroom is’, and ‘bowel movements in daytime’ were the significant independent risk factors in DLSS.

Conclusion

About 85% patients after IPAA gave positive answers in terms of DLSS. DLSS significantly correlated with IBDQ scores, which indicated DLSS can discriminate a patient’s sense of subjective well-being. Functional outcomes after IPAA were also acceptable.