Biopsychosocial determinants of health-related quality of life after ileal pouch anal anastomosis for ulcerative colitis.

Background: In patients with ileal pouch anal anastomosis (IPAA) the influences of psychosocial variables and of extraintestinal manifestations of ulcerative colitis (UC) on health-related quality of life (HRQOL) have not been studied so far. Methods: 61 patients with UC (age 52.7 ± 13.9 years; 47% female) completed the German version of the Inflammatory Bowel Disease Questionnaire (IBDQ-D), the Short Form Health Survey (SF – 36), the German version of the Hospital Anxiety and Depression Scale (HADS-D) and the Giessener Symptom List (GBB 24). Independent of their current clinical activity 37 patients underwent endoscopies. Pouchitis was defined by the Pouch Disease Activity Score (PDAI) ≥ 7. Where possible, IPAA-patients were compared with the data for the German general population and with a clinical sample of patients with UC and no IPAA. Results: Patients with IPAA complained more about fatigue and arthralgia and a reduced physical and mental health (SF-36) than the German general population (P < 0.01). The IBDQ-total score could be predicted (adjusted R2 = 29.1, P < 0.01) by the number of operations due to IPAA-related complications (β = −18.8) and HADS-D-Anxiety scores ≥ 11 (β= −29.1). The IBDQ-subscale score “Bowel” could be predicted (adjusted R2 = 13.7, P = 0.04) by PDAI ≥ 7 (β= −9.2) and the subscale score “Systemic” (adjusted R2 = 13.3, P = 0.04) by the number of extraintestinal manifestations (β= −1.9). Conclusions: HRQOL of patients with UC and IPAA is determined not only by IPAA-related factors but also by anxiety and extraintestinal manifestations with associated musculoskeletal pain.