No abstract

Background: Although irritable bowel syndrome (IBS) is not a life-threatening condition, it can have a serious impact on a patient’s daily activities and quality of life. This effect on quality of life has not been compared previously across different cultures. Methods: We compared measures of health-related quality of life and health care resource utilization using a cross-sectional point-in-time postal survey of a random sample of 500 members of the International Foundation for Functional Gastrointestinal Disorders in the US and 500 members of the IBS Network support group in the UK. The analysis was limited to persons who reported that a physician had told them they had IBS. A general health status questionnaire, the SF-36, and a disease-specific questionnaire, the Irritable Bowel Syndrome Quality of Life questionnaire (IBSQOL), were self-administered as part of the survey to measure health-related quality of life. Results on the SF-36 were compared with published normative data for adults in the US and UK with and without chronic diseases. Results: The UK group (n = 343) reported significantly poorer quality of life on the SF-36 and on four parameters of the IBSQOL than did the US group (n = 287). The general health status of persons with IBS in either country was much poorer compared with that of general populations in the respective countries. Health care resource utilization (i.e. emergency room, doctor and hospital outpatient visits) of persons with IBS was similar in the two countries, as was the direct effect of IBS on employment. Nearly one third of those surveyed missed at least 1 day of work due to IBS in the previous 4 weeks, and a greater percentage cut back in their work or activites due to IBS. Taken together, average time lost or cut back amounted to nearly 5 days or 1 work-week. Conclusion: IBS has a significant impact on quality of life and resource use in both the US and UK. The effect on quality of life, however, appears to be greater in the UK than in the US.

CDAI remission is associated with reduced hospitalizations and surgeries, increased employment, and normalized quality of life. Sustained CDAI remission should be the key therapeutic goal in managing Crohn's disease.

Objective. To determine whether the effects of anti-tumor necrosis factor ␣ (TNF␣) in reducing the signs and symptoms of ankylosing spondylitis (AS) coincide with a reduction in spinal inflammation as detected by magnetic resonance imaging (MRI).Methods. Pre-and postgadolinium T1 and STIR MR images of the spine were acquired at baseline and at week 24 in patients with AS who participated in a multicenter, randomized, double-blind, placebocontrolled study. Patients were randomly assigned at an 8:3 ratio to receive infusions of infliximab (5 mg/kg) or placebo at weeks 0, 2, and 6 and then every 6 weeks thereafter. MR images were obtained and evaluated independently by 2 readers who were blinded to the treatment allocation and time sequence of the images.Results. A total of 194 patients in the infliximab group and 72 patients in the placebo group had evaluable images at baseline and week 24. About 80% of the patients had at least 1 active spinal lesion at baseline, as assessed by MRI. The improvement in the MRI Activity Score after 6 months was significantly greater in the patients who received infliximab (mean 5.02, median 2.72) than in those who received placebo (mean 0.60, median 0.0) (P < 0.001). Almost complete resolution of spinal inflammation was seen in most patients who received infliximab, irrespective of baseline activity.Conclusion. Patients with AS who received infliximab therapy showed a decrease in spinal inflammation as detected by MRI, whereas those who received placebo showed persistent inflammatory spondylitis.

Infliximab therapy substantially improved HRQL in patients with UC. This benefit was sustained through 1 yr with maintenance infliximab therapy.