P0761 Patient-reported outcomes are associated with calprotectin levels in post-IPAA patients
Authors: Fischman M , Godny L , Friedenberg A , Barkan R , Pauker M , White I , Wasserberg N , Dotan I , Ollech J 
Published: January 2025

Background

Patient-reported outcome measures (PROMs) in inflammatory bowel disease (IBD), such as the Short IBD Questionnaire (SIBDQ)1, assess IBD impact on patients' quality of life (QoL). We aimed to validate the SIBDQ in patients with ulcerative colitis (UC) who underwent ileal pouch-anal anastomosis (IPAA) surgery and to correlate disease activity with QoL.

Methods

This prospective, observational study recruited patients with UC post-IPAA attending a comprehensive pouch clinic at a tertiary referral center (Rabin Medical Center). Upon each visit, patients completed the SIBDQ and underwent routine clinical and laboratory assessments, including blood and fecal tests. Fecal calprotectin (FCP) was chosen as a marker of active pouch disease2. Spearman’s rank correlation was used to evaluate the relationship between FCP levels and PROMs. Wilcoxon’s rank sum test was used to compare different groups.

Results

The study included 166 patients with UC with 1,016 visits (median age 50 years, IQR 37–63.5; 56.6% female). SIBDQs were completed in 941 (93%) visits. A significant negative correlation was noted between FCP levels and total SIBDQ scores (p&lt;0.001). In specific SIBDQ domains, correlations between FCP and fatigue (p=0.005), depression (p=0.04), anxiety (p=0.004), and urgency (p&lt;0.001) were noted as well (Figure 1). Additionally, FCP levels correlated with daily bowel movements (BMs) (p&lt;0.001), which, in turn, correlated with total SIBDQ score (p&lt;0.001).

In patients with chronic pouch inflammation (n=71, 42.7%; 327 visits), FCP levels were significantly higher (548.6 vs. 328.3 μg/g, p&lt;0.001) and SIBDQ scores significantly lower (47.6 vs. 54.5, p&lt;0.001) compared to the rest of the cohort. Notably, among those with chronic complications receiving biologic therapy, FCP levels decreased (461.6 vs. 593.9 μg/g, p=0.009), and SIBDQ scores improved (45.8 vs. 49.8, p=0.001).

Conclusion

Elevated FCP levels correlate with lower SIBDQ scores, suggesting that active pouch inflammation may affect patient’s quality of life. Specific PROMs, such as fatigue, depression, anxiety, and urgency, were also associated with FCP levels, highlighting them as key areas affected by inflammation. Targeting inflammatory activity, such as by biologic therapy, was associated with improved SIBDQ scores. These correlations suggest that the burden of inflammation may contribute to different PROMs and overall well-being in patients with a pouch. This emphasizes the importance of the patient’s quality of life when aiming for inflammation control, further highlighting the alignment between disease activity and overall well-being in patients with pouch.

References

1.Irvine EJ, Zhou Q, Thompson AK. The Short Inflammatory Bowel Disease Questionnaire: a quality of life instrument for community physicians managing inflammatory bowel disease. CCRPT Investigators. Canadian Crohn's Relapse Prevention Trial. Am J Gastroenterol. 1996 Aug;91(8):1571-8. PMID: 8759664.

2.Ollech JE, Bannon L, Maharshak N, Bar N, Goren I, Tulchinsky H, Yanai H, Dotan I. Fecal Calprotectin Is Increased in Pouchitis and Progressively Increases With More Severe Endoscopic and Histologic Disease. Clin Gastroenterol Hepatol. 2022 Aug;20(8):1839-1846.e2. doi: 10.1016/j.cgh.2021.11.012. Epub 2021 Nov 16. PMID: 34798336.