THE SOCIAL TOLL OF INFLAMMATORY BOWEL-DISEASE

Inflammatory bowel disease (IBD) - ulcerative colitis and Crohn's dise ase - has become one the most important chronic digestive disorders fo und in the younger population. As a results of the nature of the illne ss, with remission and exacerbation of the inflammatory process, there has been increasing concern regarding the costs, both financial and s ocial, of IBD. There have been attempts to quantify disease activity a nd to assess the results of treatment and the ability of the patient t o function in society. As a result, there has been an increased intere st in the 'social toll' of IBD. Beginning in 1988, and using a direct interview technique, ambulatory patients with IBD were evaluated for q uality of life at the Cleveland Clinic Foundation. Included were patie nts whose disease had been present for about 10 years, and both surgic al and nonsurgical patients. The interview questionnaire consisted of 47 items in four categories: functional/economic, social/recreational, affect/life in general and medical/symptoms. Patients with ulcerative colitis had better quality of life than those with Crohn's disease an d patents without surgery had better quality of life than those who ha d undergone surgery. Over the ensuing five-year period, it was shown t hat quality of life measures are of value in assessing the results of medical and surgical therapy, and the measures frequently give informa tion not usually obtained by physicians and have implications for qual ity assurance and outcome measurement.