Abstract
Purpose
Symptomatic perianal fistulas impair quality of life in patients with Crohn’s disease. Fecal diversion improves symptoms but may impair quality of life. This study was designed to compare long-term quality of life in patients with Crohn’s disease with symptomatic perianal fistulas who were treated with or without fecal diversion.
Methods
From 1996 to 2002, perianal fistulas were treated in 116 patients with Crohn’s disease. A questionnaire, including four quality of life instruments, was mailed to each patient (Short-Form General Health Survey, Gastrointestinal Quality of Life Index, Cleveland Global Quality of Life Score, Short Inflammatory Bowel Disease Questionnaire).
Results
Questionnaires were returned by 77 of 116 patients (66 percent). Thirty-four of these patients had undergone fecal diversion, whereas 43 had not. Median follow-up was 49 (range, 18–97) months in diverted and 44 (range, 14–98) months in undiverted patients (not significant). In the diverted group, 44 percent complained of Crohn’s disease-related symptoms, which was less compared with 79 percent in undiverted patients (P < 0.05). Diverted patients achieved 68 ± 1 percent of the maximum possible score on the Gastrointestinal Quality of Life Index compared with 60 ± 2 percent in undiverted patients (mean ± standard error of the mean; P < 0.001); diverted patients scored better on the subscale “gastrointestinal symptoms” of the Gastrointestinal Quality of Life Index (81 ± 1 percent vs. 67 ± 2 percent; P < 0.001). There was no difference in the Short Inflammatory Bowel Disease Questionnaire between diverted and undiverted patients except for the subscale “bowel function” (91 ± 2 percent vs. 76 ± 2 percent; P < 0.0001). No difference in quality of life was detected by the Short-Form General Health Survey and Cleveland Global Quality of Life Score.
Conclusions
In the investigated population of patients with Crohn’s disease, quality of life seems to be similar or potentially superior in diverted patients suffering from perianal fistulas compared with undiverted patients. A diverting stoma, therefore, may improve quality of life in patients with severe perianal Crohn’s disease.
Similar content being viewed by others
References
Irvine EJ. Patients’ fears and unmet needs in inflammatory bowel disease. Aliment Pharmacol Ther 2004;20:54–9.
American Gastroenterological Association Clinical Practice Committee. American Gastroenterological Association medical position statement: perianal Crohn’s disease. Gastroenterology 2003;125:1503–7.
Schwartz DA, Pemberton JH, Sandborn WJ. Diagnosis and treatment of perianal fistulas in Crohn’s disease. Ann Intern Med 2001;135:906–18.
Rutgeerts P. Treatment of perianal fistulizing Crohn’s disease. Aliment Pharmacol Ther 2004;20:106–10.
Singh B, Mortensen NJ, Jewell DP, George B. Perianal Crohn’s disease. Br J Surg 2004;91:801–14.
Present DH, Rutgeerts P, Targan S, et al. Infliximab for the treatment of fistulas in Patients with Crohn’s disease. N Engl J Med 340:1398–405.
Makoviec F, Jehle EC, Starlinger M. Clinical course of perianal fistulas in Crohn’s disease. Gut 1995;37:696–701.
Andersson P, Olaison G, Bendtsen P, Myrelid P, Sjödahl R. Health-related quality of life in Crohn’s proctocolitis does not differ from general population when in remission. Colorectal Dis 2003;5:56–62.
Edwards CM, George BD, Jewell DP, Warren BF, Mortensen NJ, Kettlewell MG. Role of a defunctioning stoma in the management of large bowel Crohn’s disease. Br J Surg 2000;87:1063–6.
Nugent KP, Daniels P, Stewart B, Patankar R, Johnson CD. Quality of life in stoma patients. Dis Colon Rectum 1999;42:1569–74.
Gooszen AW, Geelkerken RH, Hermans J, Lagaay MB, Gooszen HG. Quality of life with a temporary stoma: ileostomy vs. colostomy. Dis Colon Rectum 2000;43:650–5.
Engel J, Kerr J, Schlesinger-Raab A, Eckel R, Sauer H, Hoelzel D. Quality of life in rectal cancer patients. A four-year prospective study. Ann Surg 2003;238:203–13.
Kreis ME, Jehle EC, Ohlemann M, Becker HD, Starlinger MJ. Functional results after transanal rectal advancement flap repair of trans-sphincteric fistula. Br J Surg 1998;85:240–2.
Ware JE Jr, Snow KK, Kosinski M, Gandek B. SF-36 health survey: manual and interpretation guide. Boston: The Health Institute, New England Medical Center, 1993.
Fazio VW, O’Riordain MG, Lavery IC, et al. Long-term functional outcome and quality of life after stapled restorative proctocolectomy. Ann Surg 1999;230:575–86.
Irvine EJ, Feagan B, Rochon J, et al. Quality of life: a valid and reliable measure of therapeutic efficacy in the treatment of inflammatory bowel disease. Gastroenterology 1995;106:287–96.
Rose M, Fliege H, Hildebrandt M, et al. Validierung der deutschsprachigen Version des “short inflammatory bowel disease questionnaire“ (SIBDQ). Z Gastroenterol 2000;38:277–86.
Irvine EJ, Zhou Q, Thompson AK. The short inflammatory bowel disease questionnaire: a quality of life instrument for community physicians managing inflammatory bowel disease. CCRPT Investigators Canadian Crohn’s Relapse Prevention Trial. Am J Gastroenterol 1996;91:1571–8.
Eypasch E, Williams JI, Wood-Dauphinee S, et al. Gastrointestinal Quality of Life Index: development, validation and application of a new instrument. Br J Surg 1995;82:216–22.
Eypasch E, Wood-Dauphinee S, Williams JI, Ure B, Neugebauer E, Troidl H. Der Gastrointestinale Lebensqualitaetsindex (GLQI). Ein klinimetrischer Index zur Befindlichkeitsmessung in der gastroenterologischen Chirurgie. Chirurg 1993;64:264–74.
Brown H, Randle J. Living with a stoma: a review of the literature. Clin Nurs 2005;14:74–81.
Marquis P, Marrel A, Jambon B. Quality of life in patients with stomas: the Montreux Study. Ostomy Wound Manage 2003;49:48–55.
Thaler K, Dinnewitzer A, Oberwalder M, Weiss EG, Nogueras JJ, Wexner SD. Assessment of long-term quality of life after laparoscopic and open surgery for Crohn’s disease. Colorectal Dis 2005;7:375–81.
Feagan BG, Yan S, Bala M, Bao W, Lichtenstein GR. The effects of infliximab maintenance therapy on health-related quality of life. Am J Gastroenterol 2003;98:2232–8.
Kiran RP, Delaney CP, Senagore AJ, et al. Prospective assessment of Cleveland global quality of life (CGQL) as a novel marker of quality of life and disease activity in Crohn’s disease. Am J Gastroenterol 2003;98:1783–9.
Delaney CP, Kiran RP, Senagore AJ, et al. Quality of life improves within 30 days of surgery for Crohn’s disease. J Am Coll Surg 2003;196:714–21.
Jowell SL, Seal CJ, Barton JR, Welfare MR. The Short Inflammatory Bowel Disease questionnaire is reliable and responsive to clinically important change in ulcerative colitis. Am J Gastroenterol 2001;96:2921–8.
Maartense S, Dunker MS, Slors FM, et al. Laparoscopic-assisted versus open ileocolic resection for Crohn’s disease. A randomized trial. Ann Surg 2006;243:143–9.
Van Assche G, Vanbeckevoort D, Bielen D, et al. Magnetic resonance imaging of the effect of infliximab on perianal fistulizing Crohn’s disease. Am J Gastroenterol 2003;98:332–9.
Bell SJ, Williams AB, Wiesel P, Wilkinson K, Cohen RC, Kamm MA. The clinical course of fistulating Crohn’s disease. Aliment Pharmacol Ther 2003;17:1145–51.
Caprilli R, Gassull MA, Escher JC, et al. for the European Crohn’s and Colitis Organisation. European evidence based consensus on the diagnosis and management of Crohn’s disease: special situations. Gut 2006;55:i36–58.
Thornton M, Solomon MJ. Long-term indwelling seton for complex anal fistulas in Crohn’s disease. Dis Colon Rectum 2005;48:459–63.
O’Connor L, Champagne BJ, Ferguson MA, Orangio GR, Schertzer ME, Armstrong DN. Efficacy of anal fistula plug in closure of Crohn’s anorectal fistulas. Dis Colon Rectum 2006;49:1569–73.
Johnson EK, Gaw JU, Armstrong DN. Efficacy of anal fistula plug vs. fibrin glue in closure of anorectal fistulas. Dis Colon Rectum 2006;49:371–6.
Ozuner G, Hull TL, Cartmill J, Fazio VW. Long-term analysis of the use of transanal rectal advancement flaps for complicated anorectal/vaginal fistulas. Dis Colon Rectum 1996;39:10–4.
Hurst RD, Molinari M, Chung TP, Rubin MA, Michelassi F. Prospective study of the features, indications, and surgical treatment in 513 consecutive patients affected by Crohn’s disease. Surgery 1997;122:661–8.
Fichera A, McCormack R, Rubin MA, Hurst RD, Michelassi F. Long-term outcome of surgically treated Crohn’s colitis: a prospective study. Dis Colon Rectum 2005;48:963–9.
McKee R, Keenan RA. Perianal Crohn’s disease: is it all bad news? Dis Colon Rectum 1996;39:136–42.
Galandiuk S, Kimberling J, Al-Mishlab TG, Stromgerb AJ. Perianal Crohn’s disease. Predictors of need for permanent diversion. Ann Surg 2005;241:796–802.
Casellas F, Vivancos JL, Sampedro M, Malagelada JR. Relevance of the phenotypic characteristics of Crohn’s disease in patient perception of health-related quality of life. Am J Gastroenterol 2005;100:2737–42.
Cohen RD. The quality of life in patients with Crohn’s disease. Aliment Pharmacol Ther 2002;16:1603–9.
Lapidus A, Bernell O, Hellers G, Lofberg R. Clinical course of colorectal Crohn’s disease: a 35-year follow-up study of 507 patients. Gastroenterology 1998;114:1151–60.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Kasparek, M.S., Glatzle, J., Temeltcheva, T. et al. Long-Term Quality of Life in Patients with Crohn’s Disease and Perianal Fistulas: Influence of Fecal Diversion. Dis Colon Rectum 50, 2067–2074 (2007). https://doi.org/10.1007/s10350-007-9006-5
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10350-007-9006-5