Variables influencing health related quality of life in patients with inflammatory bowel disease

Variables influencing health related quality of life in patients with inflammatory bowel disease

S1399 (66.7%), isolated large bowel disease in 14 (19.4%), and isolated small bowel disease in 10 (13.9%) of the 72 incident cases. Adjusted mean ann...

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S1399

(66.7%), isolated large bowel disease in 14 (19.4%), and isolated small bowel disease in 10 (13.9%) of the 72 incident cases. Adjusted mean annual incidence rates of UC and CD were 1.00 (95% CI, 0.85-1.15) and 0.35 (95% CI, 0.27-0.43) per 100,000 inhabitants, respectively On December 31, 2001, 164 patients with UC and 64 patients with CD lived in the study area, giving adjusted prevalence rates of 14.51 (95% CI, 12.24-16.78) and 5.30 (95% CI, 3.99-6.61) per 100,000 inhabitants, respectively. Using the Poisson regression analysis, the annual incidence rates of UC and CD increased significantly from 0.28 and 0.02 per 100,000 inhabitants in 1986-1989 to 1.77 and 0.86 per 100,000 inhabitants in 1998-2001, respectively (p <0.05) The incidence ratio of UC to CD decreased from 14.0 in 1986-1989 to 2.1 in 1998-2001. Family history of inflammatory bowel disease was noted in only 1.3% of the patients. Conclusions: The incidence and prevalence of UC and CD in our study area are still low compared with those of Western coumries, but the incidence rates are steadily increasing. Although the mean annual incidence of UC is higher than that of CD, the incidence ratio of UC to CD is decreasing in Korea.

Variables Influencing Health Related Quality of Life in Patients with Inflammatory Bowel Disease Tomm Bernklev, Bjorn Moum; jorgen Jahnsen, Morten Vam Background: In addition to symptoms and clinical signs, health related quality of life (HRQOL) has become an important tool in evaluating patient outcome and satisfaction in inflammato D' bowel disease (IBD). So far, few have conducted prospecnve follow-up studies identifyil~g variables that influence this HRQOL. Aim: To identify variables that influence HRQOL five years after diagnosis in patients with ulcerative colitis (UC) or Crohn's disease (CD), included in.a prospective follow-up study from 1990 to 1994, the Inflammatoe/Bowel South-Eastern Norway (IBSEN) study. Methods: In addition to a clinical examination by a gastroenterologist and registration of demographic and clinical data, all patients completed the Inflammatory Bowel Disease Questionnaire (IBDQ), a disease specific quality of life questionnaire translated and validated in Norwegian (1). We present data from 328 UCpatients and 169 CD-patients, mean age 43.3 years, 48 per cent female. The impact of different demographic and clinical variables on IBD-patients HRQOL were analyzed with parametric testing A multiple linear regression (MLR) analyze was used to determine the relationship between independent vanables (demographic and clinical data) and the dependent vanable (IBDQ total score) Only variables with p<0.01 were included in the regression analysis. Results: We found that gender (female), diagnose (CD), use of ghicocorticoids and immunosuppressive drugs, relapse during the observation period, number of relapses last year (1 or more) and extra-intestinal manifestations all reduced the HRQOL score in IBD patients The MLR analyze showed that gender (female) and number of relapses last year were those variables contributing most to the explained variance in 1BDQ total score for UC-patiems, while the corresponding variables for CD-patients were use of glucocorticoids and number of relapses last year. Conclusion: Several demographic and clinical variables contribute to the reduction in HRQOL in IBD-patients, measured by the IBDQ Female gender, treatment with ghicocorticoids and one or more clinical relapse last year are the variables that contribute most to the explained variance in IBDQ total score. 1) Bernklev et a) Scand J Gastroemerol 2002; 37:1164-1174

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Mood Disorders and Disease Severity Are the Strongest Predictors of Healthrelated Quality of Life (HRQOL) in Crohn's Disease and Ulcerative Colitis E. J. Irvine, Forough Farrokhyar, Brock Easterbrook, John K Marshall Background: Antidepressants are effective treatmem for depression in chronic medical illness (Cochrane Review ab001312, 2002). HRQOL status is determined by both disease-related factors (previously shown in CD and UC to correlate strongly with disease activity) and psychosocial factors. Aim: To explore the relationship between the presence and severity of mood disorders (anxiety or depression) and HRQOL in patients with CD and UC. Methods: Consecutive patients attending an.ambulatory GI clinic completed a survey of disease activity. quality of life (Euroqol EQ-5D; 0 death - 1.0 perfect health; short IBDQ 1 poor to 7 best), and the Hospital Anxiety and Depression Survey (HADS score >7 possible,>10 definite anxiety or depression. Results: 360 (121 UC, 239 CD) patients participated; 622% had active disease, 42.4% possible and 22.5% definite anxiety &/or depression. CD patients had lower mean EQ-SD scores than UC (0.71 vs. 0.78 p = .000) and were significantly more likely to have problems walking (23% vs. 12%p = .012) or pain and discomfort (70% vs, 60%; p = .007) but the prevalence of anxiety and depression were similar. The strongest predictors of poor HRQOL in CD and UC (p = .000; 55% variance explained) were active disease, presence of any mood disorder and shorter duration of disease (UC only). Greater mood disturbance (higher HADS scores) significantly predicted (ANOVA p = .000) poorer mean SIBDQ scores (Table) and EQ-5D scores (data not shown) in both UC and CD. Conclusion: A considerable proportion of IBD patients experience a serious mood disorder that is clearly associated with impaired HRQOL. Such patients could gain impprtant health benefits from mood altering drug therapy. Study supported by the IO1BD.

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Familial Occurrence of IBD in Ulcerative Colitis and Crohn's Disease Patients and The Significance of This For Disease Behaviour Bjorn Mourn, Jorgen Jahnsen, Morten Vain, Tomm Bernklev Background: The familial occurrence of inflammatory bowel disease (1BD)in ukerative colitis (UC) and Crohn's disease (CD) patients has been shown to be higher than expected in firstdegree relatives. Whether these patients have more severe disease and disease course has been questioned. Aim: To determine the occurrence of familial IBD in a population-based cohort of prospectively registered patients and to compare the disease behawour and disease severity in these patients with that of patients without a first-degree IBD relative Material and method: IBD patients registered from 1990 to 1994 under the IBSEN study were followed up clinically for 5 years in a prospective survey. In addition, the 454 patients with UC and 200 patients with CD were interviewed twice after the diagnosis about IBD relatives. Results: At diagnosis 108% of the patients with CD and 7.4% of the patients with UC reported a first-degree relative with IBD. Five years later these figures were 14.5% and 10.4% respectively. There is a concordance for CD of 4:1 and for UC of 2:1. Age at diagnosis for the patients with CD and a first-degree relative was 7 years younger than for patients without familial IBD. This phenomenon (anticipation) was not found in UC. Patients with CD and a first-degree relative with IBD were found to have a higher risk of re-operation (p<0.05) and tended to have more severe disease and disease course (more relapsing disease, higher disease activity, and a higher risk of penetrating disease and upper gastromtestinal affection). Unlike patients with UC, CD patients with a first-degree relative had reduced quality of life compared with patients without familial IBD, as determined by the Norwegian IBDQ (p=0 014) Conclusion: Patients with UC and CD are much more likely to have a firstdegree relative with familial IBD than expected, which support the hypothesis that the etiology has a genetic component Patients with CD and a first-degree relative with IBD have a family member with CD in 80% of cases. In patients with CD and a first-degree [amily member with IBD, anticipation has a time interval of 7 years, a phenomenon which is not seen in UC CD patients vath a first-degree family member with IBD will tend to experience a more serious disease course. This could also explain the reduced quality of life, which is not seen in UC patients.

Mean SIBDQ by Severity of Deprossionand Anxiety HADS score UC No depression <8 5.62 Possible 8-t0 4.50 D~lnite >10 4.35 No anxiety <8 5.8t Possible 8-t0 4.86 DeQnlte>10 4.76 p = .000 (ANOVA)by severityof mooddisorderrange SIBDO 1=poorto 7=best

$1403 Predictors for The Use of Complementary and Alternative Medicine (CAM) in Patients with IBD , Jost Langhorst, Ulf Steder-Neukamm, Inga Anthonisen, Guenther Spahn, Andreas Michalsen, Gustav Dobos Objectives: It is well known that IBD patients rank high among users of CAM. In order to elucidate the determinants of this phenomenon we examined the CAM use in patients with IBD in Germany. Methods: After validation of a questionnaire including 73 items (disease specifics, socio-demographics, conventional treatment and complementary treatment) and completion of a pilot study a representative sample of the approx. 16000 members of the German Crohn's disease (CD) - ulcerative colitis (CU) foundation were enrolled in a postal study. Results: Of the 1000 questionnaires which were randomised and mailed 684 were completed (61.4% female, 58.3% CD, 38.2% UC). 52.9% of all adults (355 of N =671) were experienced in using CAM, with a sigmficant difference in disease (48.3% in CD, 59.8% in UC, p = 0.0133) but not in gender. Remarkably 10.5% were temporarily and 35% were permanently exclusively treated with CAM. Probiotics (54.3%), homeopathy (52.9%) and herbal medicine (43.6%) were most common methods used in CAM. Among personal reasons given for CAM use the search for an "optimum treatment" (78.9%) and the wish to terminate a steroid medication (63.8%) ranked highest. The total amount of cortisone intake was a strong predictor of CAM use (corr. 0.117, p=0.003), but there was no correlation in CAM use and the duration of disease. Furthermore younger age (p = 0.01) and activity in sports (p=0.002) was significantly correlated with using CAM. Another predictor of CAM use was personal experience in psychosomatic and psychotherapeutic support (corr. 0.156, p<0.001). Despite the fact that 80% were interested in using CAM in the future, only 24.7% felt sufficiently informed about CAM. CONCLUSIONS: More than 50% of a large group of German IBD patients have experience in using CAM. A prolonged or rather intensive use of steroids, younger age and active ways of coping with the chronic disease (psychotherapy and sports) seem to be strong predictors of using CAM. In order to avoid adverse effects of CAM, physicians should include thorough information about CAM in counselling.

$1401 Epidemiology of Inflammatory Bowel Disease in the Songpa-Kangdong District, Seoul, Korea, 1986-2001: A KASID Study Suk-Kyun Yang, In Sung Song, Young-Ho Kim, Hak Yang Kim, Eui-Ryun Park, Kyung Jo Kim, Jong Beom Park, Soo Hyun Yang, Ji Won Kim, Seung-Jae Myung, Jin-Ho Kim, Young 11 Min Background and Aims: Ulcerative colitis (UC) and Crohn's disease (CD) are regarded as rare diseases in developing countries, but accurate data are generally lacking. We performed the present study to evaluate the incidence and prevalence of UC and CD in Korea. Methods: A retrospective study was performed from 1986 to 2001 in the Songpa-Kangdong district of Seoul, Korea To recruit patients as completely as possible, multiple information sources including all medical facilities in the study area and three referral centers located nearby, but outside the study area were used. The incidence and prevalence rates were adjusted using the 2001 Korean population statistics. Results: During the srudy period, a total of 182 incident cases of UC (M:F=88:94) and 72 incident cases of CD (M:F=5I:21) were identified The mean age at diagnosis (UC, 368 years; CD 23.1 years) and the mean interval from onset of symptoms to diagnosis (UC 11.6 months; CD 27.6 months) were fairly constant throughout the study period. At the diagnosis of UC, proctitis was noted in 75 eases (41.2%), left-sided colitis in 53 (29 1%), and extensive colitis in 54 (297%) of the 182 incident cases At the diagnosis of CD, both large and small bowel disease was noted in 48 cases

AGA Abstracts

CD 5.30 3,75 3.06 5.45 4.64 3.80

A-210