Impact of surgery for Crohn's disease on health-related quality of life

OBJECTIVE: When patients with Crohn's disease (CD) express concerns about t heir disease, they emphasize worries about surgery. However, most studies a bout the impact of surgery in CD on health-related quality of life (HRQOL) have compared postsurgical changes on HRQOL relative to HRQOL before surger y, not taking into account the influence of CD activity on HRQOL. Our aim w as to assess whether surgical treatment of CD modifies HRQOL, compared with inactive CD, active CD, or healthy controls. METHODS: Outcomes of 29 CD patients in remission with a previous bowel rese ction were compared with those from 42 clinically active CD patients and 48 patients with medically induced remission. A reference control group of 63 healthy individuals was also studied. HRQOL was measured by the Inflammato ry Bowel Disease Questionnaire (IBDQ), the Psychological General Well Being Index (PGWBI), and the EuroQol. RESULTS: Active CD patients scored the lowest on the LBDQ. Both operated an d nonoperated inactive CD patients had lower HRQOL scores than controls in overall LBDQ and in all five domains. However, neither global score, digest ive, systemic, emotional, social, or functional dimensions differed signifi cantly between operated and nonoperated inactive CD patients. PGWBI and the visual analog scale of the EuroQol were also similar in both groups of ina ctive CD patients (103 [range, 93-107] vs 103 [97-106] and 90 [73-87] vs 82 [76-84]), but significantly higher than in active CD. CONCLUSIONS: HRQOL is impaired in active CD, and improves during remission irrespective of whether it had been achieved medically or surgically. Our r esults suggest that to improve HRQOL it is more important to achieve remiss ion than the approach, drugs or surgery, chosen. (Am J Gastroenterol 2000;9 5:177-182. (C) 2000 by Am. Cell, of Gastroenterology)