Commentary: impact of MMX mesalazine on health-related quality of life in ulcerative colitis.
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ABSTRACT: Perceived stigma has been linked to disease outcome in several chronic illnesses. Stigmatization of illness often leads to increased psychological distress and poorer quality of life. While body stigma has been identified as a specific inflammatory bowel disease (IBD) patient concern, no study to date has systematically investigated the presence of stigma in IBD or its effects on disease course and management. Participants were recruited online and through the Illinois chapter of the Crohn's & Colitis Foundation of America. A screening measure was used to identify an established IBD diagnosis. Patients completed the Perceived Stigma Scale in IBS, Inflammatory Bowel Disease Questionnaire, Rosenberg Self-Esteem Scale, General Self-Efficacy Scale, the Brief Symptom Inventory, and the Rating Form of IBD Patient Concerns. A total of 211 patients (156 CD, 55 UC) with a confirmed diagnosis for a minimum of 6 months completed the study. Eighty-four percent of participants reported perceived stigma. Hierarchical regression demonstrated that perceived stigma accounted for 10%-22% of the variance in health-related quality of life scores, 4%-16% for psychological distress, 5% for medication adherence, 19% for self-esteem, and 8% for self-efficacy. Effect sizes were small, but comparable with more traditionally evaluated patient variables. The majority of IBD patients report some perceived stigmatization. These results suggest that perceived stigma is a significant predictor of poorer outcomes in patients with IBD when controlling for illness and demographic variables. Perceived stigma is a potentially important psychosocial factor in IBD patient care and warrants further investigation.Inflammatory Bowel Diseases 01/2009; 15(8):1224-32. · 5.12 Impact Factor
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ABSTRACT: Health-related quality of life (HRQOL) has become an important tool in evaluating patient satisfaction in inflammatory bowel disease (IBD). So far, few prospective follow-up studies have been done to identify variables that influence HRQOL. We aimed to identify demographic and clinical variables that influence HRQOL 5 years after diagnosis in patients with ulcerative colitis (UC) or Crohn disease (CD) included in a prospective follow-up study from 1990 to 1994 (the IBSEN study). All patients completed the Inflammatory Bowel Disease Questionnaire (IBDQ), a disease-specific quality-of-life questionnaire translated into Norwegian and validated. We present data from 497 patients (328 UC patients and 169 CD patients, mean age 43.3 years, 48% female). The impact of age, gender, smoking, symptom severity, disease distribution, rheumatic symptoms and surgery on IBD patients' HRQOL was analysed. Women had a reduction in IBDQ total score of 10 points compared to men, CD patients had a reduction of 7.5 compared to UC patients. The patients with moderate/severe symptoms had a 50 points lower score than the patients without symptoms. The patients with rheumatic symptoms had a 10 points lower total score than the patients without these symptoms. All differences were statistically significant. The multiple regression analysis showed that symptom severity, rheumatic symptoms and female gender were the strongest predictors of reduction in HRQOL for both diagnosis groups. IBD symptoms, rheumatic symptoms and female gender have a significant influence on patients' HRQOL as measured by IBDQ. This was confirmed by the regression analysis.Scandinavian Journal of Gastroenterology 05/2004; 39(4):365-73. · 2.33 Impact Factor
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ABSTRACT: Past studies with ulcerative colitis (UC) patients indicate that disease activity strongly predicts health-related quality of life (HRQL). To examine the degree to which daily treatment with MMX mesalazine predicts improved HRQL for patients with active UC and with stable HRQL for patients with quiescent UC. Data from two phases of a multicentre open-label trial were examined. In the acute phase, 132 patients with mild-to-moderate active UC received MMX mesalazine 2.4-4.8 g/day for 8 weeks, while 206 patients with quiescent UC received MMX mesalazine 2.4 g/day for a 12-month maintenance phase. Disease-specific HRQL was measured at baseline and endpoint of each phase using the Short Inflammatory Bowel Disease Questionnaire (SIBDQ). Repeated-measures anova models examined baseline-endpoint changes in SIBDQ, stool frequency (SF), and rectal bleeding severity (RBS). Correlations assessed the associations between SIBDQ and SF/RBS scores, while ancova techniques tested the sensitivity of SIBDQ to disease recurrence. SIBDQ scores significantly increased for active mild-to-moderate UC patients following 8 weeks of treatment, while SIBDQ scores remained stable for quiescent UC patients following 12 months of treatment. Changes in SIBDQ scores correlated significantly with changes in SF and RBS scores. Patients with recurrent UC at maintenance phase endpoint had significantly lower SIBDQ scores than nonrecurrent patients. Daily MMX mesalazine therapy was associated with significant improvement in disease-specific HRQL for patients with mild-to-moderate active UC and with the maintenance of HRQL for patients with quiescent UC. In both patient groups, HRQL was significantly associated with disease activity.Alimentary Pharmacology & Therapeutics 04/2012; 35(12):1386-96. · 4.55 Impact Factor
Commentary: impact of MMX mesalazine
on health-related quality of life in
A. M. R. Marsh & A. J. Lobo
Gastroenterology and Liver Unit, Royal Hallamshire Hospital, Sheffield,
mesalazine therapy is associated with improvement in
disease-specific, health-related quality of life (HRQL), as
measured by the short inflammatory bowel disease
questionnaire (SIBDQ), in patients with mild-moderate
active ulcerative colitis (UC) and that this HRQL is
treatment is continued.1
In addition to its central finding, this study adds evidence
of the previously suggested relationship between HRQL and
patient-reported measures of disease activity – including
stool frequency (SF) and rectal bleeding score (RBS).2, 3
Ulcerative colitis carries a significant psychological and
social burden.4, 5Maintaining HRQL is therefore important
in long-term management and increasingly recognised as a
critical end-point in randomised controlled trials in UC.
Patient-reported measures are non-invasive and may be
simple, capturing features of importance to patients.
The authors stressed the correlation between changes
in the SIBDQ and the SF and RBS, suggesting that the
improvements in HRQL are mediated through improve-
ments in bowel symptoms. However, there were signifi-
cant improvements in all domains of the SIBDQ over
the acute phase, although more patients showed an
improvement in the bowel symptoms domain than the
other domains, implying a smaller effect size for these
Interpretation of the data is limited by the lack of a
comparator arm, variable treatment dose in the acute
phase and incomplete data availability (only 103/137 had
interpretable data at the beginning and end of the acute
phase). Multiple statistical comparisons were made and it
is not clear whether appropriate adjustments were made.
Despite its limitations, this study helpfully documents
improvement or maintenance of HRQL with MMX
mesalazine treatment, but cannot confirm that the effect
is due to treatment or its size. This - as the authors indi-
cate - would require a randomised, controlled study.
Declaration of personal and funding interests: None.
1. Solomon D, Yarlas A, Hodgkins P, Karlstadt R, Yen L, Kane S.
The impact of MMX mesalazine on disease-specific health-related
quality of life in ulcerative colitis patients. Aliment Pharmacol
Ther 2012; 35: 1386–96.
2. Bernklev T, Jahnsen J, Asdland E, Marsh AMR, Lobo AJ. Health-
related quality of life in patients with inflammatory bowel disease
five years after the initial diagnosis. Scand J Gastroenterol 2004;
3. Han SW, McColl E, Barton JR, James P, Steen IN, Welfare MR.
Predictors of quality of life in ulcerative colitis: the importance of
symptoms and illness representations. Inflamm Bowel Dis 2005;
4. Taft TH, Keefer L, Leonhard C, Nealon-Woods M. Impact of
perceived stigma on inflammatory bowel disease patient
outcomes. Inflamm Bowel Dis 2009; 15: 1224–32.
5. Wolfe BJ, Sirois FM. Beyond standard quality of life measures:
the subjective experiences of living with inflammatory bowel
disease. Qual Life Res 2008; 17: 877–86.
Aliment Pharmacol Ther 2012; 36: 398-402
ª 2012 Blackwell Publishing Ltd