Effect of Surgery on Health-Related Quality of Life in Patients With Inflammatory Bowel Disease

Thirlby, Richard C.; Land, John C.; Fenster, Laura; Lonborg, Rocelyn

doi:10.1001/archsurg.133.8.826

Cited by 95 publications

(74 citation statements)

References 19 publications

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“…Health-related quality-of-life scores improve after surgery in patients with inflammatory bowel disease [31]. This has not yet been evaluated after strictureplasty and resection.…”

Section: Discussionmentioning

confidence: 99%

Quality of Life after Surgical Therapy of Small Bowel Stenosis in Crohn’s Disease

Bröering¹,

Eisenberger²,

Koch³

et al. 2001

Dig Surg

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Background: Improvement in quality of life is one of the important determinants in the treatment of Crohn’s disease. Since there is no cure with radical resection of inflamed bowel, strictureplasty has become a useful surgical technique in the treatment of small bowel obstruction. The scope of this study was to define the results of strictureplasty and resection in terms of quality of life, surgical recurrence and postoperative complications. Methods: The charts of 67 patients with Crohn’s disease of the small bowel were analyzed retrospectively. Patients were treated either by strictureplasty (group A) or resection (group B). Quality of life was evaluated in follow-up examinations using the Inflammatory Bowel Disease Questionnaire (IBDQ). Results: Postoperative morbidity was 14.8% after strictureplasty and 17% after resection (p = 0.8). 50% of the patients treated by strictureplasty and 37% treated by resection developed recurrent disease (p = 0.40). Quality-of-life measurement revealed no significant difference between patients treated by strictureplasty or resection. Conclusion: Results after strictureplasty are comparable to those after resection in terms of complications, recurrence and quality of life in the treatment of small bowel strictures in Crohn’s disease. In the long run there might be an advantage for strictureplasty because it prevents complications caused by resectional therapy such as short bowel syndrome.

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“…Health-related quality-of-life scores improve after surgery in patients with inflammatory bowel disease [31]. This has not yet been evaluated after strictureplasty and resection.…”

Section: Discussionmentioning

confidence: 99%

Quality of Life after Surgical Therapy of Small Bowel Stenosis in Crohn’s Disease

Bröering¹,

Eisenberger²,

Koch³

et al. 2001

Dig Surg

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“…e primary objective of therapy for CD is to restore the patient to health and well-being. Quality of life typically can be restored a er surgical resection or stricturoplasty for CD (254,256) . erefore, medical therapies are acceptable only if they achieve their inductive or maintenance goals safely and e ectively with a satisfactory quality of life.…”

Section: Indications For Surgerymentioning

confidence: 99%

“…erefore, medical therapies are acceptable only if they achieve their inductive or maintenance goals safely and e ectively with a satisfactory quality of life. Neither patients nor physicians should view surgery as a " failure " when it can be the swi est, safest, and most e ective route to physical and psychosocial rehabilitation (38,254,256) .…”

Section: Indications For Surgerymentioning

confidence: 99%

Management of Crohn's Disease in Adults

2009

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Guidelines for clinical practice are intended to suggest preferable approaches to particular medical problems as established by interpretation and collation of scientifi cally valid research, derived from extensive review of published literature. When data that will withstand objective scrutiny are not available, a recommendation may be made based on a consensus of experts. Guidelines are intended to apply to the clinical situation for all physicians without regard to specialty. Guidelines are intended to be fl exible, not necessarily indicating the only acceptable approach, and should be distinguished from standards of care that are infl exible and rarely violated. Given the wide range of choices in any health-care problem, the physician should select the course best suited to the individual patient and the clinical situation presented. These guidelines are developed under the auspices of the American College of Gastroenterology and its Practice Parameters Committee. Expert opinion is solicited from the outset for the document. The quality of evidence upon which a specifi c recommendation is based is as follows: Grade A: Homogeneous evidence from multiple well-designed randomized (therapeutic) or cohort (descriptive) controlled trials, each involving a number of participants to be of suffi cient statistical power. Grade B: Evidence from at least one large well-designed clinical trial with or without randomization, from cohort or case -control analytic studies, or well-designed meta-analysis. Grade C: Evidence based on clinical experience, descriptive studies, or reports of expert committees. The Committee reviews guidelines in depth, with participation from experienced clinicians and others in related fi elds. The fi nal recommendations are based on the data available at the time of the production of the document and may be updated with pertinent scientifi c developments at a later time.

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“…Thus, a prospective randomized study in 131 patients found similar recurrence rates whether margins were 2 or 12 cm [5]. Resection with or without stricturoplasty has a significant beneficial impact on patients’ quality of life [6]. This chapter does not address the issue of resective surgery for acute or chronic active Crohn’s disease which is resistant to medical treatment or of anorectal disease.…”

Section: Treatmentmentioning

confidence: 99%

Fibrostenotic Crohn’s Disease

et al. 2007

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Crohn’s disease is often complicated by gastrointestinal strictures. Postoperative recurrence at the anastomotic site is common and repeated surgical interventions may be necessary. Medical treatment may relieve active inflammation (see chapter on active luminal disease) but fibrous strictures will not respond to this. Mechanical treatment methods consist of endoscopic balloon dilation, stricturoplasty or surgical resection. Fibrostenotic Crohn’s disease does not respond to medical therapy and requires endoscopic or surgical treatment.

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Effect of Surgery on Health-Related Quality of Life in Patients With Inflammatory Bowel Disease

Cited by 95 publications

References 19 publications

Quality of Life after Surgical Therapy of Small Bowel Stenosis in Crohn’s Disease

Quality of Life after Surgical Therapy of Small Bowel Stenosis in Crohn’s Disease

Management of Crohn's Disease in Adults

Fibrostenotic Crohn’s Disease

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