QUALITY-OF-LIFE IN CROHNS-DISEASE - RESULTS OF A CASE-CONTROL STUDY

Objective: To investigate the impact of Crohn's disease on the quality of life of patients using an index of health. Study design: Investigative structure of a retrospective case-control study. Setting: University Hospital Rotterdam - a regional referral centre in the Province of Zuid Holland, The Netherlands. Study population: The study included 120 patients with established Crohn's disease and 75 community-based controls of similar demographic background. Measurements: Index of health assessed and calculated from personal interview using a structure questionnaire. Results: The index of health for Crohn's disease patients at 0.7 +/- 0.3 compared with controls (0.9 +/- 0.1, t = 6.6, P < 0.00001). This was largely due to impaired physical health, with only 6% of patients completely satisfied compared with 51% of controls (chi2 = 35.6, P < 0.0001). Although the differences were much less marked for mental health, 64% of the patients with Crohn's disease were less than completely satisfied; this was significantly higher than the 47% level for controls (P < 0.01). Excretion, feeding, work, sleep, dependence on others, mental health, communication and sexual activity were all affected. Only hobbies and recreational pursuits were not adversely influenced by the disease. Disease-specific aspects of the study showed that even when their disease was in temporary abatement or diminution, 73% of patients had complaints. Diarrhoea, abdominal pain and chronic tiredness were the three most important disease related problems identified by the patients. Men were more often affected than women (P < 0.02). Surgery and anti-inflammatory drugs both played some part in the improved quality of life, but patient perception of the benefits of surgery declined rapidly after the first operation and remained uniformly low, while the opinion of drug treatment improved (chi2 = 34, P < 0.001). Conclusion: The principal conclusion of our study is that Crohn's disease has adverse impact on the quality of life of patients. Doubt is cast on the assumption that surgery results in a better quality of life than medical therapy.