Long-Term Quality-of-Life and Functional Outcomes After Ileal Pouch-Anal Anastomosis for Ulcerative Colitis
AIBD 2023
Background:
Reports on the long-term impact on quality of life (QoL) and functional outcomes after ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC) are scarce in Latin America. This study aimed to report QoL and functional outcomes after IPAA in an inflammatory bowel disease (IBD) reference center.
Methods:
A standardized questionnaire was administered to patients with UC undergoing IPAA from March 2023 to August 2023. The questions aimed to assess the quality of life and evacuation function after IPAA. Specifically, we assessed the following: (1) daily frequency of bowel movements, (2) fecal incontinence during both daytime and nighttime, (3) dependency on daily medication, such as loperamide, to enhance bowel function, (4) fecal urgency (5) Social limitations (6) fatigue (7) impact on sexual life (8) Dependency on diapers (9) Impact on the ability to work.
Results:
In total, 28 patients underwent total proctocolectomy with IPAA. Most patients were female (19, 67.9%) with an average age of 44.8±10.2 years. The mean follow-up time after surgery was 13.8 years on average. Patients reported an average of 6.0±1.8 bowel movements per day, with 27 (96.4%) experiencing episodes of diarrhea. In most cases, the use of diapers was unnecessary (22, 78.6%). Most patients reported nocturnal bowel movements (24, 85.7%), with nightly awakenings being a common occurrence for most (15, 53.6%). Additionally, most patients experienced episodes of nocturnal fecal incontinence (23, 92.9%), fecal urgency (17, 60.7%), and anal bleeding (15, 53.6%). Loperamide was required by 21 patients (75%) to reduce the frequency of bowel movements. Regarding the impact of surgery on quality of life, most patients reported some degree of fatigue (27, 96.4%), a negative impact on sexual life (18, 64.3%), challenges in social and work activities (22, 78.6%), and feelings of shame regarding their health status (21, 75%). Despite these negative impacts, most patients did not have dietary restrictions (17, 60.7%). Overall, 22 (78.6%) patients reported satisfaction with the surgical procedure.
Conclusions:
In conclusion, despite the high levels of satisfaction with IPAA in the long term, patients had a negative impact on bowel habit and on various aspects of QoL. The information obtained is of great value and can help to develop strategies to improve the quality of life of future patients undergoing IPAA.
