A comparison of the quality of life in patients with severe ulcerative colitis after total colectomy versus medical treatment with intravenous cyclosporin

Cyclosporin (CSA) has emerged as a medical alternative to colectomy in seve re, steroid-refractory ulcerative colitis (UC) patients. This is the first formal quality-of-life study comparing such patients treated with intraveno usly administered cyclosporin with those treated surgically with colectomy. Quality-of-life analyses were conducted in all patients who underwent cole ctomy or received intravenous CSA for severe UC from 1991 to 1995 using the Inflammatory Bowel Disease Questionnaire, a visual-analog scale (VAS), and the Oresland scale, with additional questions regarding health care utiliz ation and medication use. The 18 CSA-treated patients reported a better abi lity to sleep (p = 0.0021 VAS), better stool consistency (p < 0.001; VAS), less abdominal or rectal pain (p = 0.009, VAS), and fewer daytime (p < 0.00 1; Oresland), nighttime (p = 0.006; Oresland), and daily trips to the toile t (p < 0.001; VAS) than the 46 surgical patients. The mean number and rate of hospitalizations within the first year was also lower in the CSA patient s (p < 0.001 for both). The surgical patients reported fewer initial visits to their specialist (p < 0.001) and less medication use (p < 0.001; Oresla nd). Patients with severe steroid-refractory UC treated with intravenously administered CSA scored as well as or better than their surgical counterpar ts. The use of CSA in selected patients is substantiated both by clinical r esults and qualify-of-life analysis.