Quality of life after ileal pouch-anal anastomosis: an evaluation of diet and other factors using the Cleveland Global Quality of Life instrument.

Hdl Handle:
http://hdl.handle.net/10147/209054
Title:
Quality of life after ileal pouch-anal anastomosis: an evaluation of diet and other factors using the Cleveland Global Quality of Life instrument.
Authors:
Coffey, J C; Winter, D C; Neary, P; Murphy, A; Redmond, H P; Kirwan, W O
Affiliation:
Department of Academic Surgery, Cork University Hospital, Cork, Ireland.
Citation:
Dis Colon Rectum. 2002 Jan;45(1):30-8.
Journal:
Diseases of the colon and rectum
Issue Date:
3-Feb-2012
URI:
http://hdl.handle.net/10147/209054
PubMed ID:
11786761
Abstract:
PURPOSE: Although functional results after ileal pouch-anal anastomosis are excellent, imperfections of function do occur. In this setting, quality-of-life assessment is an invaluable tool in determining overall therapeutic efficacy. We evaluated the impact of dietary restrictions, preoperative diagnosis (ulcerative colitis vs. familial adenomatous polyposis), and pregnancy (after pouch insertion) on quality of life. METHODS: After ethical approval, 64 patients were reviewed (mean age, 31 (range, 15-54) years). Long-term quality of life in patients after ileal pouch-anal anastomosis was assessed using the Cleveland Global Quality of Life instrument or Fazio score. The Cleveland Global Quality of Life score is a novel quality-of-life instrument specifically designed for patients with ileal pouches. Stool frequency and continence were recorded to establish the functional status of this group. RESULTS: Sixty-one patients (95.3 percent) complained of some form of dietary restriction and adopted a fixed dietary regimen. All such patients felt that a breach of this regimen would impinge significantly on their quality of life. Late eating and alcohol were associated with diarrhea, whereas smoking was not. Constipation was infrequently reported. The mean Cleveland Global Quality of Life score of patients with ulcerative colitis (0.81 +/- 0.13) was greater than that of patients with ulcerative colitis and a background of pouchitis (0.78 +/- 0.16; P = 0.042). Whereas postoperative stool frequency in patients with familial adenomatous polyposis was always higher than the preoperative level (4 vs. 2 movements per day; P = 0.04), the Cleveland Global Quality of Life score of this group was lower than that of ulcerative colitis patients (0.77 vs. 0.81; P = 0.047). The Cleveland Global Quality of Life score of females who had had pregnancies after pouch formation was 0.70, significantly lower (P = 0.039) than that of ulcerative colitis patients, although pouch function was similar to the general group (7 vs. 6 daily bowel movements with full continence in all parous patients). CONCLUSIONS: Most patients suffered dietary restrictions, forcing them to adopt a fixed dietary regimen. Breach of this regimen would impact on their quality of life. Hence composition of diet and timing of intake are important determinants of quality of life after ileal pouch formation. Patients with familial adenomatous polyposis and those with a history of pouchitis had poorer Cleveland Global Quality of Life scores than ulcerative colitis patients without a background of pouchitis. This indicates that they also had poorer quality of life. Parous patients had the lowest Cleveland Global Quality of Life scores, indicating the poorest quality of life. These differences did not correlate with poorer pouch function, highlighting the influence of non-pouch-related factors in quality of life after ileal pouch formation.
Language:
eng
MeSH:
Adenomatous Polyposis Coli/*diet therapy/physiopathology/*surgery; Adolescent; Adult; Anastomosis, Surgical; Colitis, Ulcerative/*diet therapy/physiopathology/*surgery; Colon/physiopathology/surgery; Defecation/physiology; Female; Follow-Up Studies; Food Habits/*physiology; Humans; Life Style; Male; Middle Aged; Pregnancy; Preoperative Care; *Proctocolectomy, Restorative; *Quality of Life; Time Factors; Treatment Outcome
ISSN:
0012-3706 (Print); 0012-3706 (Linking)

Full metadata record

DC FieldValue Language
dc.contributor.authorCoffey, J Cen_GB
dc.contributor.authorWinter, D Cen_GB
dc.contributor.authorNeary, Pen_GB
dc.contributor.authorMurphy, Aen_GB
dc.contributor.authorRedmond, H Pen_GB
dc.contributor.authorKirwan, W Oen_GB
dc.date.accessioned2012-02-03T15:11:01Z-
dc.date.available2012-02-03T15:11:01Z-
dc.date.issued2012-02-03T15:11:01Z-
dc.identifier.citationDis Colon Rectum. 2002 Jan;45(1):30-8.en_GB
dc.identifier.issn0012-3706 (Print)en_GB
dc.identifier.issn0012-3706 (Linking)en_GB
dc.identifier.pmid11786761en_GB
dc.identifier.urihttp://hdl.handle.net/10147/209054-
dc.description.abstractPURPOSE: Although functional results after ileal pouch-anal anastomosis are excellent, imperfections of function do occur. In this setting, quality-of-life assessment is an invaluable tool in determining overall therapeutic efficacy. We evaluated the impact of dietary restrictions, preoperative diagnosis (ulcerative colitis vs. familial adenomatous polyposis), and pregnancy (after pouch insertion) on quality of life. METHODS: After ethical approval, 64 patients were reviewed (mean age, 31 (range, 15-54) years). Long-term quality of life in patients after ileal pouch-anal anastomosis was assessed using the Cleveland Global Quality of Life instrument or Fazio score. The Cleveland Global Quality of Life score is a novel quality-of-life instrument specifically designed for patients with ileal pouches. Stool frequency and continence were recorded to establish the functional status of this group. RESULTS: Sixty-one patients (95.3 percent) complained of some form of dietary restriction and adopted a fixed dietary regimen. All such patients felt that a breach of this regimen would impinge significantly on their quality of life. Late eating and alcohol were associated with diarrhea, whereas smoking was not. Constipation was infrequently reported. The mean Cleveland Global Quality of Life score of patients with ulcerative colitis (0.81 +/- 0.13) was greater than that of patients with ulcerative colitis and a background of pouchitis (0.78 +/- 0.16; P = 0.042). Whereas postoperative stool frequency in patients with familial adenomatous polyposis was always higher than the preoperative level (4 vs. 2 movements per day; P = 0.04), the Cleveland Global Quality of Life score of this group was lower than that of ulcerative colitis patients (0.77 vs. 0.81; P = 0.047). The Cleveland Global Quality of Life score of females who had had pregnancies after pouch formation was 0.70, significantly lower (P = 0.039) than that of ulcerative colitis patients, although pouch function was similar to the general group (7 vs. 6 daily bowel movements with full continence in all parous patients). CONCLUSIONS: Most patients suffered dietary restrictions, forcing them to adopt a fixed dietary regimen. Breach of this regimen would impact on their quality of life. Hence composition of diet and timing of intake are important determinants of quality of life after ileal pouch formation. Patients with familial adenomatous polyposis and those with a history of pouchitis had poorer Cleveland Global Quality of Life scores than ulcerative colitis patients without a background of pouchitis. This indicates that they also had poorer quality of life. Parous patients had the lowest Cleveland Global Quality of Life scores, indicating the poorest quality of life. These differences did not correlate with poorer pouch function, highlighting the influence of non-pouch-related factors in quality of life after ileal pouch formation.en_GB
dc.language.isoengen_GB
dc.subject.meshAdenomatous Polyposis Coli/*diet therapy/physiopathology/*surgeryen_GB
dc.subject.meshAdolescenten_GB
dc.subject.meshAdulten_GB
dc.subject.meshAnastomosis, Surgicalen_GB
dc.subject.meshColitis, Ulcerative/*diet therapy/physiopathology/*surgeryen_GB
dc.subject.meshColon/physiopathology/surgeryen_GB
dc.subject.meshDefecation/physiologyen_GB
dc.subject.meshFemaleen_GB
dc.subject.meshFollow-Up Studiesen_GB
dc.subject.meshFood Habits/*physiologyen_GB
dc.subject.meshHumansen_GB
dc.subject.meshLife Styleen_GB
dc.subject.meshMaleen_GB
dc.subject.meshMiddle Ageden_GB
dc.subject.meshPregnancyen_GB
dc.subject.meshPreoperative Careen_GB
dc.subject.mesh*Proctocolectomy, Restorativeen_GB
dc.subject.mesh*Quality of Lifeen_GB
dc.subject.meshTime Factorsen_GB
dc.subject.meshTreatment Outcomeen_GB
dc.titleQuality of life after ileal pouch-anal anastomosis: an evaluation of diet and other factors using the Cleveland Global Quality of Life instrument.en_GB
dc.contributor.departmentDepartment of Academic Surgery, Cork University Hospital, Cork, Ireland.en_GB
dc.identifier.journalDiseases of the colon and rectumen_GB
dc.description.provinceMunster-
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