Effect of Intestinal Resection on Quality of Life in Crohn’s Disease

Emily K Wright, Michael A Kamm, Peter De Cruz, Amy L Hamilton, Kathryn J Ritchie, Efrosinia O Krejany, Alexandra Gorelik, Danny Liew, Lani Prideaux, Ian C Lawrance, Jane M Andrews, Peter A Bampton, Miles P Sparrow, Timothy H Florin, Peter R Gibson, Henry Debinski, Richard B Gearry, Finlay A Macrae, Rupert W Leong, Ian Kronborg, Graeme Radford-Smith, Warwick Selby, Michael J Johnston, Rodney Woods, P Ross Elliott, Sally J Bell, Steven J Brown, William R Connell, Paul V Desmond

Patients with Crohn's disease have poorer health related quality of life (HRQoL) than healthy individuals, even when in remission. Although HRQoL improves in patients who achieve drug induced or surgically induced remission, the effects of surgery overall have not been well characterised. In a randomised trial patients undergoing intestinal resection of all macroscopically diseased bowel were treated with post-operative drug therapy to prevent disease recurrence. All patients were followed prospectively for 18 months. CRP, CDAI and faecal calprotectin (FC) were measured pre-operatively and at 6, 12 and 18 months. HRQoL was assessed with a general (SF36) and disease-specific (IBDQ) questionnaires at the same time points. 174 patients were included. HRQoL was poor pre-operatively but improved significantly (p<0.001) at 6 months post-operatively. This improvement was sustained at 18 months. Females and smokers had a poorer HRQoL when compared to males and non-smokers respectively. Persistent endoscopic remission, intensification of drug treatment at 6 months and anti-TNF therapy were not associated with different HRQoL outcomes than if these factors were not present. There was a significant inverse correlation between CDAI, but not endoscopic recurrence, CRP or FC, on HRQoL. Intestinal resection of all macroscopic Crohn's disease in patients treated with post-operative prophylactic drug therapy is associated with significant and sustained improvement in HRQoL irrespective of type of drug treatment or endoscopic recurrence. HRQoL is lower in female patients and smokers. A higher CDAI, but not direct measures of active disease or type of drug therapy, is associated with a lower HRQoL.