Health-related quality of life in patients with long-standing ulcerative colitis in remission

Abstract

Introduction: Ulcerative colitis (UC) contributes to impaired health-related quality of life (HRQoL). Although disease activity is the most important factor, reduced HRQoL has been reported even in quiescent UC. We aimed to determine HRQoL, and identify predictors thereof, in patients with long-standing UC in remission.

Methods: In total, 66 patients with inactive UC were included 10 years after the disease onset. Clinical assessment including rigid sigmoidoscopy was performed to ensure remission. Data on demographic, clinical, treatment-related, and psychological determinants of HRQoL were obtained with a structured interview and self-assessment questionnaires measuring gastrointestinal (GI) and psychological symptoms and fatigue. HRQoL was measured with the Short Form Health Survey (SF-36).

Results: The SF-36 domains were comparable to the general Swedish population, except for Vitality, where UC patients scored lower. Gender, smoking, comorbidity, or disease phenotype had no impact on HRQoL. In contrast, corticosteroid use and sick leave during the previous year were independently associated with Physical Functioning and Bodily Pain domains of SF-36; persisting GI symptoms during remission with Bodily Pain; and fatigue with Role Physical, General Health and Vitality. For all other SF-36 domains reflecting mental HRQoL (Social Function, Role Emotional, Mental Health), only psychological distress contributed uniquely.

Conclusions: Although overall HRQoL in long-standing UC in remission is comparable to the general population, previous disease activity as well as persisting GI symptoms, fatigue, and psychological distress are associated with a lower HRQoL among these patients. Improved HRQoL may allow for better UC patient health and reduced costs for health care.

Keywords: predictors; quality of life; remission; ulcerative colitis.

Figure 1.

(a) Mean z-scores for SF-36 domains, (b) mean z-scores for SF-36 domains stratified by sex, and (c) mean z-scores for SF-36 domains stratified by age in patients with long-standing inactive ulcerative colitis. Z scores are equal to patient score minus the mean population score divided by the standard deviation of the population scores. Cohen’s effect size index for z scores; 0.2 no difference, 0.2 to 0.5 small difference, 0.5 to 0.8 moderate difference, 0.8 large difference. BP, bodily pain; GH, general health; MH, mental health; PF, physical function; RE, role emotional; RP, role physical; SF, social function; UC, ulcerative colitis; VT, vitality.

Figure 2.

SF-36 domain score comparisons (mean values) between different subgroups according to (a) gender, (b) smoking status, (c) presence of comorbidity, (d) presence of extraintestinal manifestations (EIM), and (e) disease phenotype. BP, bodily pain; EIM; extraintestinal manifestations; GH, general health; MH, mental health; PF, physical function; RE, role emotional; RP, role physical; SF, social functioning; VT, vitality. *p < 0.05. **p < 0.01.

Figure 3.

SF-36 domain score comparisons (mean values) between (a) patients reporting no relapses versus patients reporting at least one relapse during the previous years, (b) patients who used systemic corticosteroids during the previous year versus patients who did not, (c) patients with versus without sick leave due to ulcerative colitis during the previous year, (d) patients reporting no/minor gastrointestinal symptoms in remission (total GSRS score = 1–2) versus patients reporting mild/moderate symptoms (total GSRS score = 3–4), (e) patients with borderline or clinically significant anxiety/depression (at least one HAD subscore > 7) versus patients with no anxiety/depression (both HAD subscores ⩽ 7), and (f) patients with high fatigue (MFI general fatigue score ⩾ 13) versus those with low fatigue (MFI general score < 13). BP, bodily pain; GH, general health; GSRS, Gastrointestinal Symptom Rating Scale; HAD, Hospital Anxiety and Depression; MFI, Multidimensional Fatigue Inventory; MH, mental health; PF, physical function; RE, role emotional; RP, role physical; SD, standard deviation; SF, social functioning; VT, vitality. *p < 0.05. **p < 0.01. ***p < 0.001.