Nora Helene Wytrykowski Christensen [1,2], Jonas Andre Lundekvam [1,3], Johannes Kurt Schultz [2,1]

Affiliates

[1] Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway[2] Departement og gastrointestinal surgery, Akershus University Hospital, Lørenskog, Norway[3] Departement of Gastroenterology, Oslo University Hospital, Oslo, Norway

Abstract

BACKGROUND: Biologic treatment of Ulcerative Colitis has side effects, about 30% of patients fail to respond to first-line treatment and 45% loose efficacy (1). This has an impact on Health-related Quality of Life, (HRQoL). The alternative, colectomy, with or without reconstruction of bowel continuity (IPAA or IRA), on the other hand, has a considerable risk of complications. The aim of this systematic review was to compare the effect of medical and surgical UC treatment on HRQoL and disability.

METHODS: A systematic search was performed in Medline (Ovid), Embase (Ovid) and Scopus, using controlled vocabulary and text words. We included articles published after the year 1999 in English, German or a Scandinavian language, comparing HRQoL or disability in patients treated for UC with surgery or biologics. Titles and abstracts were screened by two separate reviewers using Rayyan. A full-text analysis was done of all studies with an inconclusive abstract in terms of the inclusion criteria, and of all included studies.
RESULTS: After removing duplicates, 2905 eligible articles were identified (Figur 1). Of these 243 abstracts reported on HRQoL and/or disability in UC patients treated with surgery and/or biologics. Of these, five studies were identified which directly compared HRQoL and/or disability between UC patients treated with either biologics or surgery (2,3,4,5,6). These are summarized in Table 1.

Generic HRQoL instruments
Three studies reported the 36-item short form survey (SF-36) (2,5,6). No significant differences in overall SF-36 score were found in two studies (2,6). In one of these the surgical group scored lower for physical function. The third study reported higher SF-36 scores in the IPAA group, than the anti-TNFα group (5), even if use of antidiarrheal medication was significantly higher after IPAA. The EuroQol- 5 Dimension 3level instrument (EQ5D3L) was reported in two studies. One study indicated a higher score in IPAA patients compared to ileostomy patients (3), while the other found no difference between the groups (5).

Disease specific Quality of Life instruments
Concerning the disease specific quality of life, three studies reported the Inflammatory Bowel Disease Questionnaire (IBDQ). They found similar total scores in surgically and medically treated patients (3,4,6). One study found lower scores in the surgical group for the social dimension of the IBDQ.

Disability
One study report that IPAA patients report lower disability than medically treated (4), another reports no significant difference (2).

CONCLUSION: The overall quality of life in UC patients after both surgical and biological treatment is good, and quite similar, whereas disability was reported similar or lower after surgical treatment. Surgically treated patients reported an increased use of antidiarrheal medication. Surgery is a good alternative to biological treatment in UC and should be discussed with patients as such.

REFERENCES:
1. Singh S, et al. Clin Gastroenterol Hepatol. 2020 September; 18(10): 2179–2191
2. Meijs S, et al. J Crohn’s Colitis. 2014 Jul;8(7):686–92
3. van der Valk M, et al. J Crohn’s Colitis. 2015 Aug: 1016-23.
4. Lee Y, et al. J Crohn’s Colitis. 2016 Jun: 1378-84.
5. van Gennep S, et al. European Journal of Gastroenterology & Hepatology 2017, 29:338-344.
6. Francisco P, et al. Digestion 2020, 101:631–637.
7. Leong RWL, et al. J Crohns Colitis 2014;8:1237–45

Poster_P10_Nora-Helene-Wytrykowski-Christensen