Barnes Edward L, Herfarth Hans H, Sandler Robert S, Chen Wenli, Jaeger Elizabeth, Nguyen Van M, Robb Amber R, Kappelman Michael D, Martin Christopher F, Long Millie D
*Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; †Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; and ‡Division of Pediatric Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Inflamm Bowel Dis. 2017 Jul;23(7):1218-1224. doi: 10.1097/MIB.0000000000001119.
Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) has become the standard surgical treatment for the majority of patients with inflammatory bowel disease (IBD) who require colectomy. We evaluated the prevalence of pouch-related symptoms among the Crohn's and Colitis Foundation of America Partners cohort and the effect of pouch-related symptoms on Patient-Reported Outcome Measurement Information System measures.
We performed analyses nested in the Crohn's and Colitis Foundation of America Partners cohort. We used bivariate analyses to compare demographics and medication use among patients with ulcerative colitis or indeterminate colitis and pouch-related symptoms and those with IPAA without symptoms. We also compared Patient-Reported Outcome Measurement Information System domains (measured in T-scores) and short IBD questionnaire quality of life scales between symptomatic pouch patients (over the past 6 mo) and those without symptoms.
Among 243 patients reporting a history of IPAA, 199 (82%) reported a history of pouch symptoms. Patients with recent pouch symptoms demonstrated higher mean T-scores in pain interference (53.0 versus 45.3; P < 0.001), depression (51.0 versus 46.4; P = 0.002), and fatigue (56.3 versus 47.0; P < 0.001). Symptomatic pouch patients reported lower mean scores in social role satisfaction (47.4 versus 54.6) and short IBD questionnaire (4.8 versus 5.8) (both P < 0.001). These differences were all clinically meaningful.
In a large sample of patients with IBD, nearly all patients with IPAA reported a history of pouch symptoms. Patients experiencing symptoms within the 6 months before the survey assessment demonstrated clinically meaningful decrements in patient-reported outcomes in multiple domains of physical and psychosocial functioning.
回肠储袋肛管吻合术（IPAA）的恢复性直肠结肠切除术已成为大多数需要结肠切除术的炎症性肠病（IBD）患者的标准外科治疗方法。我们评估了美国克罗恩病和结肠炎基金会合作伙伴队列中储袋相关症状的患病率以及储袋相关症状对患者报告结局测量信息系统指标的影响。
我们在美国克罗恩病和结肠炎基金会合作伙伴队列中进行了嵌套分析。我们使用双变量分析比较溃疡性结肠炎或不确定性结肠炎患者以及有储袋相关症状的患者与无症状IPAA患者的人口统计学和药物使用情况。我们还比较了有症状的储袋患者（过去6个月内）和无症状患者之间的患者报告结局测量信息系统领域（以T评分衡量）和简短IBD问卷生活质量量表。
在243例报告有IPAA病史的患者中，199例（82%）报告有储袋症状病史。近期有储袋症状的患者在疼痛干扰（53.0对45.3；P<0.001）、抑郁（51.0对46.4；P = 0.002）和疲劳（56.3对47.0；P<0.001）方面的平均T评分更高。有症状的储袋患者在社会角色满意度（47.4对54.6）和简短IBD问卷（4.8对5.8）方面的平均得分较低（均P<0.001）。这些差异均具有临床意义。
在一大群IBD患者中，几乎所有接受IPAA的患者都报告有储袋症状病史。在调查评估前6个月内出现症状的患者在身体和心理社会功能的多个领域中，患者报告的结局出现了具有临床意义的下降。
