P0562 Evaluation of the impact of fistulizing disease on quality of life in Crohn's disease
Authors: Kani H T , Ergenc I , Ozsarac B , Sahin B N , Kaya G , Ozutemiz B , Demir B C , Atug O , Ozen Alahdab Y 
Published: January 2025

Background

Crohn's disease (CD) is a chronic, remitting disease with sometimes inadequate response to the treatment and these factors may impact the quality of life of patients. Our study aims to evaluate the impact of fistulizing disease, different treatment options and disease activity on the quality of life of in CD.

Methods

Patients who applied to the inflammatory bowel disease outpatient clinic between August 2021 and September 2023 were invited to the study respectively. Patients who agreed to participate were included in the study. The quality of life of the patients was assessed with the Inflammatory Bowel Disease Questionnaire (IBDQ), and disease activity was assessed with the Crohn's Disease Activity Index (CDAI). In addition, the Perianal Disease Activity Index (PDAI) was used in those with perianal disease. The quality of life scores of the patients were compared in terms of clinical and demographic parameters.

Results

A total of 209 patients enrolled in our study; 103 (49.3%) were non-fistulizing and 106 (50.7%) were fistulizing. 78 of the fistulizing patients had perianal fistula. A moderately strong and statistically significant negative correlation was found between CDAI and total IBDQ (r=-.538, p&lt;0.001). A statistically significant negative correlation was found between PDAI and total IBDQ (r=-.372, p=0.001). Although the mean total IBDQ value of nonfistulizing patients (148.97 ±36.41) was higher than fistulizing patients (144.61±37.46), fistulizing status did not significantly affect the total IBDQ score (p=0.395). Being a woman significantly affects all sub-scores of IBDQ score and total IBDQ score. Although the mean total IBDQ score of patients under biological treatment was higher than who were not using them; the difference was not significant (p=0.771). In addition, the quality of life score was significantly lower in those with a diagnosis of spondyloarthropathy (p=0.012).

Conclusion

In the current literature, the presence of perianal fistula has been shown to have a negative effect on quality of life in several studies (1,2,3). Our study revealed a negative relationship between PDAI and CDAI values and total IBDQ score. In addition, our study showed that gender had a significant effect on total IBDQ, while fistulizing condition, use of biological agents, and surgical history did not affect the total IBDQ score. It is possible that this partial difference with the current literature is due to the difference of quality of life assesments.

References

1-Spinelli A, Yanai H, Girardi P, Milicevic S, Carvello M, Maroli A, Avedano L. The Impact of Crohn's Perianal Fistula on Quality of Life: Results of an International Patient Survey. Crohns Colitis 360. 2023 Jul 25;5(3):otad036. doi: 10.1093/crocol/otad036. PMID: 37529012; PMCID: PMC10390083.

2-Kato M, Yoneyama-Hirozane M, Iwasaki K, Matsubayashi M, Igarashi A. Health-related quality of life in health states corresponding to different stages of perianal fistula associated with Crohn's disease: a quantitative evaluation of patients and non-patients in Japan. J Mark Access Health Policy. 2023 Jan 15;11(1):2166374. doi: 10.1080/20016689.2023.2166374. PMID: 36684854; PMCID: PMC9848226.

3-Karki C, Athavale A, Abilash V, Hantsbarger G, Geransar P, Lee K, Milicevic S, Perovic M, Raven L, Sajak-Szczerba M, Silber A, Yoon A, Tozer P. Multi-national observational study to assess quality of life and treatment preferences in patients with Crohn's perianal fistulas. World J Gastrointest Surg. 2023 Nov 27;15(11):2537-2552. doi: 10.4240/wjgs.v15.i11.2537. PMID: 38111766; PMCID: PMC10725550.