Skip to main content
Erschienen in: International Journal of Colorectal Disease 5/2014

01.05.2014 | Original Article

Quality of life after proctocolectomy and ileal pouch-anal anastomosis in patients with ulcerative colitis

verfasst von: Steffen Koerdt, Ekkehard C. Jehle, Martin E. Kreis, Michael S. Kasparek

Erschienen in: International Journal of Colorectal Disease | Ausgabe 5/2014

Einloggen, um Zugang zu erhalten

Abstract

Purpose

While ileal pouch-anal anastomosis is performed in many patients with ulcerative colitis, conflicting data exist about its effects on quality of life. We aimed to determine quality of life and to identify risk factors for impaired quality of life in these patients.

Methods

Forty-eight of 82 patients (59 %; median follow-up 57 months [range 21–93 months]) after ileal pouch-anal anastomosis for ulcerative colitis were compared to 48 matched healthy controls. Generic, health-, and disease-related, as well as symptom-specific quality of life was analyzed using five well-established quality of life instruments.

Results

Although generic quality of life was comparable between groups, health-related quality of life was impaired after ileal pouch-anal anastomosis. While high stool frequency was associated with impaired health-related and disease-specific quality of life, fecal incontinence and history of pouchitis also caused a deterioration of generic and symptom-related quality of life. Seventy-seven percent of patients reported their quality of life to be better compared to the situation before surgery and 88 % would undergo ileal pouch-anal anastomosis again.

Conclusions

Overall quality of life after ileal pouch-anal anastomosis is good. However, high stool frequency, fecal incontinence, and pouchitis are associated with impaired quality of life and should be prevented or treated to the best possible extent.
Literatur
1.
Zurück zum Zitat Kornbluth A, Sachar DB (2010) Ulcerative colitis practice guidelines in adults: American College Of Gastroenterology, Practice Parameters Committee. Am J Gastroenterol 105:501–523, quiz 24PubMedCrossRef Kornbluth A, Sachar DB (2010) Ulcerative colitis practice guidelines in adults: American College Of Gastroenterology, Practice Parameters Committee. Am J Gastroenterol 105:501–523, quiz 24PubMedCrossRef
2.
Zurück zum Zitat Dignass A, Preiss JC, Aust DE, Autschbach F, Ballauff A, Barretton G, Bokemeyer B, Fichtner-Feigl S, Hagel S, Herrlinger KR, Jantschek G, Kroesen A, Kruis W, Kucharzik T, Langhorst J, Reinshagen M, Rogler G, Schleiermacher D, Schmidt C, Schreiber S, Schulze H, Stange E, Zeitz M, Hoffmann JC, Stallmach A (2011) Updated German guideline on diagnosis and treatment of ulcerative colitis, 2011. Z Gastroenterol 49:1276–1341PubMedCrossRef Dignass A, Preiss JC, Aust DE, Autschbach F, Ballauff A, Barretton G, Bokemeyer B, Fichtner-Feigl S, Hagel S, Herrlinger KR, Jantschek G, Kroesen A, Kruis W, Kucharzik T, Langhorst J, Reinshagen M, Rogler G, Schleiermacher D, Schmidt C, Schreiber S, Schulze H, Stange E, Zeitz M, Hoffmann JC, Stallmach A (2011) Updated German guideline on diagnosis and treatment of ulcerative colitis, 2011. Z Gastroenterol 49:1276–1341PubMedCrossRef
3.
Zurück zum Zitat Mowat C, Cole A, Windsor A, Ahmad T, Arnott I, Driscoll R, Mitton S, Orchard T, Rutter M, Younge L, Lees C, Ho GT, Satsangi J, Bloom S (2011) Guidelines for the management of inflammatory bowel disease in adults. Gut 60:571–607PubMedCrossRef Mowat C, Cole A, Windsor A, Ahmad T, Arnott I, Driscoll R, Mitton S, Orchard T, Rutter M, Younge L, Lees C, Ho GT, Satsangi J, Bloom S (2011) Guidelines for the management of inflammatory bowel disease in adults. Gut 60:571–607PubMedCrossRef
4.
Zurück zum Zitat de Zeeuw S, Ahmed Ali U, Donders RA, Hueting WE, Keus F, van Laarhoven CJ (2012) Update of complications and functional outcome of the ileo-pouch anal anastomosis: overview of evidence and meta-analysis of 96 observational studies. Int J Color Dis 27:843–853CrossRef de Zeeuw S, Ahmed Ali U, Donders RA, Hueting WE, Keus F, van Laarhoven CJ (2012) Update of complications and functional outcome of the ileo-pouch anal anastomosis: overview of evidence and meta-analysis of 96 observational studies. Int J Color Dis 27:843–853CrossRef
5.
Zurück zum Zitat Heikens JT, de Vries J, Goos MR, Oostvogel HJ, Gooszen HG, van Laarhoven CJ (2012) Quality of life and health status before and after ileal pouch-anal anastomosis for ulcerative colitis. Br J Surg 99:263–269PubMedCrossRef Heikens JT, de Vries J, Goos MR, Oostvogel HJ, Gooszen HG, van Laarhoven CJ (2012) Quality of life and health status before and after ileal pouch-anal anastomosis for ulcerative colitis. Br J Surg 99:263–269PubMedCrossRef
6.
Zurück zum Zitat Somashekar U, Gupta S, Soin A, Nundy S (2010) Functional outcome and quality of life following restorative proctocolectomy for ulcerative colitis in Indians. Int J Color Dis 25:967–973CrossRef Somashekar U, Gupta S, Soin A, Nundy S (2010) Functional outcome and quality of life following restorative proctocolectomy for ulcerative colitis in Indians. Int J Color Dis 25:967–973CrossRef
7.
Zurück zum Zitat Ware JE, Jr., Snow KK, Kosinski M, Gandek B (1993) SF-36 health survey: manual and interpretation guide. The Health Institute, New England Medical Center Ware JE, Jr., Snow KK, Kosinski M, Gandek B (1993) SF-36 health survey: manual and interpretation guide. The Health Institute, New England Medical Center
8.
Zurück zum Zitat Fazio VW, O’Riordain MG, Lavery IC, Church JM, Lau P, Strong SA, Hull T (1999) Long-term functional outcome and quality of life after stapled restorative proctocolectomy. Ann Surg 230:575–584, discussion 84-6PubMedCentralPubMedCrossRef Fazio VW, O’Riordain MG, Lavery IC, Church JM, Lau P, Strong SA, Hull T (1999) Long-term functional outcome and quality of life after stapled restorative proctocolectomy. Ann Surg 230:575–584, discussion 84-6PubMedCentralPubMedCrossRef
9.
Zurück zum Zitat Eypasch E, Williams JI, Wood-Dauphinee S, Ure BM, Schmulling C, Neugebauer E, Troidl H (1995) Gastrointestinal Quality of Life Index: development, validation and application of a new instrument. Br J Surg 82:216–222PubMedCrossRef Eypasch E, Williams JI, Wood-Dauphinee S, Ure BM, Schmulling C, Neugebauer E, Troidl H (1995) Gastrointestinal Quality of Life Index: development, validation and application of a new instrument. Br J Surg 82:216–222PubMedCrossRef
10.
Zurück zum Zitat Eypasch E, Wood-Dauphinee S, Williams JI, Ure B, Neugebauer E, Troidl H (1993) The Gastrointestinal Quality of Life Index. A clinical index for measuring patient status in gastroenterologic surgery. Chirurg 64:264–274PubMed Eypasch E, Wood-Dauphinee S, Williams JI, Ure B, Neugebauer E, Troidl H (1993) The Gastrointestinal Quality of Life Index. A clinical index for measuring patient status in gastroenterologic surgery. Chirurg 64:264–274PubMed
11.
Zurück zum Zitat Han SW, Gregory W, Nylander D, Tanner A, Trewby P, Barton R, Welfare M (2000) The SIBDQ: further validation in ulcerative colitis patients. Am J Gastroenterol 95:145–151PubMedCrossRef Han SW, Gregory W, Nylander D, Tanner A, Trewby P, Barton R, Welfare M (2000) The SIBDQ: further validation in ulcerative colitis patients. Am J Gastroenterol 95:145–151PubMedCrossRef
12.
Zurück zum Zitat Rose M, Fliege H, Hildebrandt M, Korber J, Arck P, Dignass A, Klapp B (2000) Validation of the new German translation version of the “Short Inflammatory Bowel Disease Questionnaire” (SIBDQ). Z Gastroenterol 38:277–286PubMedCrossRef Rose M, Fliege H, Hildebrandt M, Korber J, Arck P, Dignass A, Klapp B (2000) Validation of the new German translation version of the “Short Inflammatory Bowel Disease Questionnaire” (SIBDQ). Z Gastroenterol 38:277–286PubMedCrossRef
13.
Zurück zum Zitat Mennigen R, Senninger N, Bruewer M, Rijcken E (2012) Pouch function and quality of life after successful management of pouch-related septic complications in patients with ulcerative colitis. Langenbecks Arch Surg 397:37–44PubMedCrossRef Mennigen R, Senninger N, Bruewer M, Rijcken E (2012) Pouch function and quality of life after successful management of pouch-related septic complications in patients with ulcerative colitis. Langenbecks Arch Surg 397:37–44PubMedCrossRef
14.
Zurück zum Zitat Rockwood TH, Church JM, Fleshman JW, Kane RL, Mavrantonis C, Thorson AG, Wexner SD, Bliss D, Lowry AC (2000) Fecal Incontinence Quality of Life Scale: quality of life instrument for patients with fecal incontinence. Dis Colon Rectum 43:9–16, discussion -7PubMedCrossRef Rockwood TH, Church JM, Fleshman JW, Kane RL, Mavrantonis C, Thorson AG, Wexner SD, Bliss D, Lowry AC (2000) Fecal Incontinence Quality of Life Scale: quality of life instrument for patients with fecal incontinence. Dis Colon Rectum 43:9–16, discussion -7PubMedCrossRef
15.
Zurück zum Zitat Browning GG, Parks AG (1983) Postanal repair for neuropathic faecal incontinence: correlation of clinical result and anal canal pressures. Br J Surg 70:101–104PubMedCrossRef Browning GG, Parks AG (1983) Postanal repair for neuropathic faecal incontinence: correlation of clinical result and anal canal pressures. Br J Surg 70:101–104PubMedCrossRef
16.
Zurück zum Zitat Delaney CP, Fazio VW, Remzi FH, Hammel J, Church JM, Hull TL, Senagore AJ, Strong SA, Lavery IC (2003) Prospective, age-related analysis of surgical results, functional outcome, and quality of life after ileal pouch-anal anastomosis. Ann Surg 238:221–228PubMedCentralPubMed Delaney CP, Fazio VW, Remzi FH, Hammel J, Church JM, Hull TL, Senagore AJ, Strong SA, Lavery IC (2003) Prospective, age-related analysis of surgical results, functional outcome, and quality of life after ileal pouch-anal anastomosis. Ann Surg 238:221–228PubMedCentralPubMed
17.
Zurück zum Zitat Richards DM, Hughes SA, Irving MH, Scott NA (2001) Patient quality of life after successful restorative proctocolectomy is normal. Color Dis 3:223–226CrossRef Richards DM, Hughes SA, Irving MH, Scott NA (2001) Patient quality of life after successful restorative proctocolectomy is normal. Color Dis 3:223–226CrossRef
18.
Zurück zum Zitat Wuthrich P, Gervaz P, Ambrosetti P, Soravia C, Morel P (2009) Functional outcome and quality of life after restorative proctocolectomy and ileo-anal pouch anastomosis. Swiss Med Wkly 139:193–197PubMed Wuthrich P, Gervaz P, Ambrosetti P, Soravia C, Morel P (2009) Functional outcome and quality of life after restorative proctocolectomy and ileo-anal pouch anastomosis. Swiss Med Wkly 139:193–197PubMed
19.
Zurück zum Zitat Andersson T, Lunde OC, Johnson E, Moum T, Nesbakken A (2011) Long-term functional outcome and quality of life after restorative proctocolectomy with ileo-anal anastomosis for colitis. Color Dis 13:431–437CrossRef Andersson T, Lunde OC, Johnson E, Moum T, Nesbakken A (2011) Long-term functional outcome and quality of life after restorative proctocolectomy with ileo-anal anastomosis for colitis. Color Dis 13:431–437CrossRef
20.
Zurück zum Zitat Leowardi C, Hinz U, Tariverdian M, Kienle P, Herfarth C, Ulrich A, Kadmon M (2010) Long-term outcome 10 years or more after restorative proctocolectomy and ileal pouch-anal anastomosis in patients with ulcerative colitis. Langenbecks Arch Surg 395:49–56PubMedCrossRef Leowardi C, Hinz U, Tariverdian M, Kienle P, Herfarth C, Ulrich A, Kadmon M (2010) Long-term outcome 10 years or more after restorative proctocolectomy and ileal pouch-anal anastomosis in patients with ulcerative colitis. Langenbecks Arch Surg 395:49–56PubMedCrossRef
21.
Zurück zum Zitat Hahnloser D, Pemberton JH, Wolff BG, Larson DR, Crownhart BS, Dozois RR (2004) The effect of ageing on function and quality of life in ileal pouch patients: a single cohort experience of 409 patients with chronic ulcerative colitis. Ann Surg 240:615–621, discussion 21-3PubMedCentralPubMed Hahnloser D, Pemberton JH, Wolff BG, Larson DR, Crownhart BS, Dozois RR (2004) The effect of ageing on function and quality of life in ileal pouch patients: a single cohort experience of 409 patients with chronic ulcerative colitis. Ann Surg 240:615–621, discussion 21-3PubMedCentralPubMed
22.
Zurück zum Zitat Hahnloser D, Pemberton JH, Wolff BG, Larson DR, Crownhart BS, Dozois RR (2007) Results at up to 20 years after ileal pouch-anal anastomosis for chronic ulcerative colitis. Br J Surg 94:333–340PubMedCrossRef Hahnloser D, Pemberton JH, Wolff BG, Larson DR, Crownhart BS, Dozois RR (2007) Results at up to 20 years after ileal pouch-anal anastomosis for chronic ulcerative colitis. Br J Surg 94:333–340PubMedCrossRef
23.
Zurück zum Zitat Steens J, Meijerink WJ, Masclee AA, van Hogezand RA, Griffioen G, Post WJ, Bemelman WA (2000) Limited influence of pouch function on quality of life after ileal pouch-anal anastomosis. Hepatogastroenterology 47:746–750PubMed Steens J, Meijerink WJ, Masclee AA, van Hogezand RA, Griffioen G, Post WJ, Bemelman WA (2000) Limited influence of pouch function on quality of life after ileal pouch-anal anastomosis. Hepatogastroenterology 47:746–750PubMed
24.
Zurück zum Zitat Fichera A, Silvestri MT, Hurst RD, Rubin MA, Michelassi F (2009) Laparoscopic restorative proctocolectomy with ileal pouch anal anastomosis: a comparative observational study on long-term functional results. J Gastrointest Surg 13:526–532PubMedCrossRef Fichera A, Silvestri MT, Hurst RD, Rubin MA, Michelassi F (2009) Laparoscopic restorative proctocolectomy with ileal pouch anal anastomosis: a comparative observational study on long-term functional results. J Gastrointest Surg 13:526–532PubMedCrossRef
25.
Zurück zum Zitat Kiran RP, El-Gazzaz G, Remzi FH, Church JM, Lavery IC, Hammel J, Fazio VW (2011) Influence of age at ileoanal pouch creation on long-term changes in functional outcomes. Color Dis 13:184–190CrossRef Kiran RP, El-Gazzaz G, Remzi FH, Church JM, Lavery IC, Hammel J, Fazio VW (2011) Influence of age at ileoanal pouch creation on long-term changes in functional outcomes. Color Dis 13:184–190CrossRef
26.
Zurück zum Zitat Michelassi F, Lee J, Rubin M, Fichera A, Kasza K, Karrison T, Hurst RD (2003) Long-term functional results after ileal pouch anal restorative proctocolectomy for ulcerative colitis: a prospective observational study. Ann Surg 238:433–441, discussion 42-5PubMedCentralPubMed Michelassi F, Lee J, Rubin M, Fichera A, Kasza K, Karrison T, Hurst RD (2003) Long-term functional results after ileal pouch anal restorative proctocolectomy for ulcerative colitis: a prospective observational study. Ann Surg 238:433–441, discussion 42-5PubMedCentralPubMed
27.
Zurück zum Zitat Silvestri MT, Hurst RD, Rubin MA, Michelassi F, Fichera A (2008) Chronic inflammatory changes in the anal transition zone after stapled ileal pouch-anal anastomosis: is mucosectomy a superior alternative? Surgery 144:533–537, discussion 7-9PubMedCrossRef Silvestri MT, Hurst RD, Rubin MA, Michelassi F, Fichera A (2008) Chronic inflammatory changes in the anal transition zone after stapled ileal pouch-anal anastomosis: is mucosectomy a superior alternative? Surgery 144:533–537, discussion 7-9PubMedCrossRef
28.
Zurück zum Zitat Chapman JR, Larson DW, Wolff BG, Dozois EJ, Cima RR, Pemberton JH, Crownhart BS, Larson DR (2005) Ileal pouch-anal anastomosis: does age at the time of surgery affect outcome? Arch Surg 140:534–539, discussion 9-40PubMedCrossRef Chapman JR, Larson DW, Wolff BG, Dozois EJ, Cima RR, Pemberton JH, Crownhart BS, Larson DR (2005) Ileal pouch-anal anastomosis: does age at the time of surgery affect outcome? Arch Surg 140:534–539, discussion 9-40PubMedCrossRef
29.
Zurück zum Zitat Brisinda G, Vanella S, Valenza V, Crocco A, Perotti G, Di Giuda D, Maria G (2011) Surgical prophylaxis of pouchitis in ulcerative colitis. Dig Dis Sci 56:1257–1265PubMedCrossRef Brisinda G, Vanella S, Valenza V, Crocco A, Perotti G, Di Giuda D, Maria G (2011) Surgical prophylaxis of pouchitis in ulcerative colitis. Dig Dis Sci 56:1257–1265PubMedCrossRef
30.
Zurück zum Zitat Rokke O, Iversen K, Olsen T, Ristesund SM, Eide GE, Turowski GE (2011) Long-term follow-up with evaluation of the surgical and functional results of the ileal pouch reservoir in restorative proctocolectomy for ulcerative colitis. ISRN Gastroenterol 2011:625842PubMedCentralPubMed Rokke O, Iversen K, Olsen T, Ristesund SM, Eide GE, Turowski GE (2011) Long-term follow-up with evaluation of the surgical and functional results of the ileal pouch reservoir in restorative proctocolectomy for ulcerative colitis. ISRN Gastroenterol 2011:625842PubMedCentralPubMed
31.
Zurück zum Zitat Schmidt C, Hauser W, Giese T, Stallmach A (2007) Irritable pouch syndrome is associated with depressiveness and can be differentiated from pouchitis by quantification of mucosal levels of proinflammatory gene transcripts. Inflamm Bowel Dis 13:1502–1508PubMedCrossRef Schmidt C, Hauser W, Giese T, Stallmach A (2007) Irritable pouch syndrome is associated with depressiveness and can be differentiated from pouchitis by quantification of mucosal levels of proinflammatory gene transcripts. Inflamm Bowel Dis 13:1502–1508PubMedCrossRef
32.
Zurück zum Zitat Turina M, Pennington CJ, Kimberling J, Stromberg AJ, Petras RE, Galandiuk S (2006) Chronic pouchitis after ileal pouch-anal anastomosis for ulcerative colitis: effect on quality of life. J Gastrointest Surg 10:600–606PubMedCrossRef Turina M, Pennington CJ, Kimberling J, Stromberg AJ, Petras RE, Galandiuk S (2006) Chronic pouchitis after ileal pouch-anal anastomosis for ulcerative colitis: effect on quality of life. J Gastrointest Surg 10:600–606PubMedCrossRef
33.
Zurück zum Zitat Carmon E, Keidar A, Ravid A, Goldman G, Rabau M (2003) The correlation between quality of life and functional outcome in ulcerative colitis patients after proctocolectomy ileal pouch anal anastomosis. Color Dis 5:228–232CrossRef Carmon E, Keidar A, Ravid A, Goldman G, Rabau M (2003) The correlation between quality of life and functional outcome in ulcerative colitis patients after proctocolectomy ileal pouch anal anastomosis. Color Dis 5:228–232CrossRef
Metadaten
Titel
Quality of life after proctocolectomy and ileal pouch-anal anastomosis in patients with ulcerative colitis
verfasst von
Steffen Koerdt
Ekkehard C. Jehle
Martin E. Kreis
Michael S. Kasparek
Publikationsdatum
01.05.2014
Verlag
Springer Berlin Heidelberg
Erschienen in
International Journal of Colorectal Disease / Ausgabe 5/2014
Print ISSN: 0179-1958
Elektronische ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-013-1814-6

Weitere Artikel der Ausgabe 5/2014

International Journal of Colorectal Disease 5/2014 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare
CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare
CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare
CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.