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Quality of life in inflammatory bowel diseases: it is not all about the bowel
Ronald Keller1, Nazar Mazurak2, Laura Fantasia1
1Division of Gastroenterology, Hepatology, Infectious Diseases, Department of Internal Medicine I, University Hospital Tübingen, Tübingen, Germany.
Insights
Inflammatory bowel diseases (IBD) significantly impair quality of life (QUOL). Extraintestinal manifestations, smoking, and psychological factors negatively impact QUOL, while ostomies may improve it, especially in Crohn's disease (CD).
Area of Science:
- Gastroenterology
- Clinical Medicine
- Patient-Reported Outcomes
Background:
- Inflammatory bowel diseases (IBD), including ulcerative colitis (UC) and Crohn's disease (CD), are chronic conditions predominantly affecting young individuals.
- Quality of life (QUOL) is intrinsically linked to disease activity and is a crucial therapeutic target for lifelong conditions.
- Identifying factors influencing QUOL is essential for optimizing patient management and treatment strategies.
Purpose of the Study:
- To identify key factors contributing to either good or impaired health-related quality of life (HR-QUOL) in patients with IBD.
- To assess the impact of various clinical, psychological, and social factors on the HR-QUOL of UC and CD patients.
Main Methods:
- A cross-sectional study utilizing online questionnaires distributed via institutional and IBD self-help group webpages in Germany.
- Patients were categorized based on HR-QUOL scores (cutoff <60) using validated instruments: Short Inflammatory Bowel Disease Questionnaire, Assessment of the Demand for Additional Psychological Treatment, and Fear of Progression Questionnaire Short Form.
Main Results:
- A high prevalence of impaired HR-QUOL was observed: 87.34% in UC and 91.08% in CD patients.
- Factors associated with reduced HR-QUOL included active extraintestinal manifestations, smoking, high fear of progression, and a high demand for psychotherapy.
- Polypharmacological treatments did not correlate with good HR-QUOL, whereas ostomies were linked to improved HR-QUOL, particularly in CD patients.
Conclusions:
- Current clinical assessments focusing primarily on somatic factors are insufficient for comprehensively evaluating patient QUOL in IBD.
- Extraintestinal manifestations represent a significant, often underestimated, determinant of impaired QUOL in inflammatory bowel diseases.
- Psychological and social factors play a critical role in the overall well-being of IBD patients, necessitating integrated care approaches.
Background/Aims:
The inflammatory bowel diseases (IBD), ulcerative colitis (UC), and Crohn's disease (CD) are chronic diseases mostly affecting young patients. As they are diseases accompanying patients for their entire life, and the quality of life (QUOL) interacts with disease activity, improving QUOL should be one of the main goals of therapy. This study aims to identify factors contributing to good or impaired QUOL.
Methods:
Questionnaires addressing health-related QUOL and other psychological and social features were positioned on our institutions' webpage and on the webpage of the largest self-help group for IBD in Germany. Patients were subdivided according to their QUOL score with a cutoff of <60. We used the Short Inflammatory Bowel Disease Questionnaire, the Assessment of the Demand for Additional Psychological Treatment, and the Fear of Progression Questionnaire Short Form.
Results:
High numbers of patients in both subgroups showed an impaired QUOL (87.34% in UC, 91.08% in CD). Active extraintestinal manifestations, smoking, high fear of progression and high demand for psychotherapy were associated with reduced QUOL. In addition, polypharmacological interventions did not result in a good QUOL, but ostomies are linked to improved QUOL especially in CD patients.
Conclusions:
Scores used in clinical day-to-day-practice mainly focusing on somatic factors do not sufficiently address important aspects concerning QUOL. Most importantly, extraintestinal manifestations show a hitherto underestimated impact on QUOL.
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