. 2016 Nov 29;12(1):6–16. doi: 10.5114/pg.2016.64037

Table I.

Health-Related Quality of Life in UC and CD after surgery

Study [reference no.]	Aim of the study	HRQoL scale	Results/conclusions
Study [reference no.]	Characteristics of the study group	HRQoL scale	Results/conclusions
Sagar et al. (1993) [21]	Comparison of the QoL between patients with UC after restorative proctocolectomy and patients with UC on long-term medical treatment	Öresland scale¹² HADS⁹	HRQoL after IPAA was no worse than that of patients with UC on medical treatment
Sagar et al. (1993) [21]	103 patients after restorative proctocolectomy; 95 patients with UC on medical treatment	Öresland scale¹² HADS⁹
Yazdanpanah et al. (1997) [22]	Evaluate prospectively the impact of surgery on HRQoL in patients operated on for CD. HRQoL was assessed immediately preoperatively and 3 months postoperatively	SF-36 ¹⁷ RFIPC¹⁶	HRQoL was improved postoperatively compared with the immediate preoperative status in almost all scales. Patients’ concerns and worries decreased after surgery. However, there was no decreased in the problems associated with: having an ileostomy bag, having surgery, energy level, uncertainty of the disease, and pain or suffering
Yazdanpanah et al. (1997) [22]	CD patients (14 women, 12 men; median age 28.5 years) who have undergone an elective ileocolonic resection (n = 26)	SF-36 ¹⁷ RFIPC¹⁶
Thirlby et al. (1998) [23]	Measure the effect of surgical resection on quality of life in patients with CD and UC. CD patients underwent resection with or without strictureplasty for intractable disease; 3 UC patients underwent ileo pouch-anal anastomoses with ileoanal reservoir (preoperatively and after 3 months postoperatively)	HSQ¹⁰	Preoperative measures of HRQoL of the patients were low. Postoperatively, after 3 months, HRQoL measures improved significantly (p < 0.05) in CD and UC (scores equal to the general population in most scales)
Thirlby et al. (1998) [23]	CD patients (n = 36) and UC patients (n = 27)	HSQ¹⁰
Cohen et al. (1999) [24]	This is the first study of QoL comparing such patients with UC treated with CSA with those treated surgically with colectomy	IBDQ¹¹ VAS²¹ Öresland Scale¹²	Patients with severe steroid-refractory UC treated with CSA had similar HRQoL compared with colectomy patients
Cohen et al. (1999) [24]	18 CSA-treated patients and 46 surgical patients	IBDQ¹¹ VAS²¹ Öresland Scale¹²
Tillinger et al. (1999) [25]	Examination of short- vs. long-term effects of surgical resection for CD on HRQoL	CDAI⁴ TTO²⁰ RFIPC¹⁶	HRQoL was significantly improved in all patients 3 and 6 months post surgical resection. 12 patients had also significantly improved HRQoL after 24 months (except for the 4 patients with chronic active disease). CDAI decreased significantly after operation, and 10 patients remained in remission for 24 months. Two patients had postoperative relapses
Tillinger et al. (1999) [25]	CD patients 1 week before surgery included in the study and 3, 6, and 24 months after surgical resection (n = 16)	CDAI⁴ TTO²⁰ RFIPC¹⁶
Casellas et al. (2000) [26]	Assessment of whether surgical treatment of CD patients modifies HRQoL, and compared with inactive CD patients, active CD patients, or healthy controls	EuroQol⁶ IBDQ¹¹ PGWBI¹⁴	HRQoL is impaired in active CD, and improves during remission regardless of whether it had been achieved medically or surgically
Casellas et al. (2000) [26]	First group: 29 CD patients in remission with a previous bowel resection. Second group: 42 clinically active CD patients. Third group: 48 patients with medically-induced remission. Control group: 63 healthy individuals	EuroQol⁶ IBDQ¹¹ PGWBI¹⁴
Broering et al. (2001) [27]	Assessment of the results of strictureplasty and resection in terms of QoL, surgical recurrence, and postoperative complications	IBDQ¹¹	Results after strictureplasty were comparable to those after resection (complications, recurrence, and QoL in the treatment of small bowel strictures in CD). In the long term it can be an advantage for strictureplasty because it prevents the complications of resectional therapy
Broering et al. (2001) [27]	67 CD patients of the small bowel were analysed retrospectively. Patients were treated either by strictureplasty (group A) or resection (group B)	IBDQ¹¹
Thirlby et al. (2001) [28]	Assessment of the results of the long term in patients after surgery for UC patients and for CD patients (preoperatively and after 3, 6, and 12 months)	HSQ¹⁰	HRQoL is poor in patients with IBD referred for possible operation, (with particularly low scores in the scales of general health – health perception, role limitations due to physical health, social functioning, and energy level. Surgical resection resulted in significant improvement in HRQoL (postoperative scores are virtually equal to the scores for the general population). Aggressive surgical intervention in many patients with IBD supports the prospective study of HRQoL by surgeons treating patients with chronic diseases
Thirlby et al. (2001) [28]	CD (n = 56) and UC patients (n = 83). CD patients underwent resections with or without postoperative strictureplasties; 5 patients with UC underwent ileal pouch-anal anastomoses. The average age of CD patients was 41 years (range: 21–77 years), 24 men and 32 women. The average age of UC patients was 44 years (range: 15–75 years), with 59 men and 24 women	HSQ¹⁰
Andersson et al. (2003) [29]	Comparison of HRQoL and psychosocial conditions among CD patients and the general population	CDAI⁴ PGWB¹⁴ VAS²¹	HRQoL in these patients according to the SF-36 seems to be more dependent of present symptoms than on the type of previous surgery or the need for immunosuppressive medications – aggressive disease as well as previous colonic surgery lacked predictive value. When comparing subgroups of patients the symptom-index was the strongest predictor of HRQoL after correction for possible confounders such as age, gender, duration of disease, concomitant small bowel involvement, presence of a stoma, previous colonic surgery, and aggressive disease (above 150 score CDAI)
Andersson et al. (2003) [29]	First group: patients with Crohn’s proctocolitis, n = 127; median age 44 years (range: 18–78), 44.1% men. The median duration of disease: 16 (8–25) years. Control group: n = 266; median age: 45 years (range: 19–88 years); 50.7% men	CDAI⁴ PGWB¹⁴ VAS²¹
Camilleri-Brennan et al. (2003) [30]	Determination whether in patients suffering from UC a restorative resection with ileo pouch-anal formation offers lower morbidity and better quality of life than a permanent ileostomy	BIQ¹ IBDQ¹¹ SF-36¹⁷	There were no significant differences between the scores of IBDQ and SF-36 of the ileo pouch-anal patients and those of the ileostomy patients. Perception of body image was better in the ileo pouch-anal patients than in the ileostomy patients
Camilleri-Brennan et al. (2003) [30]	19 patients of the pouch and 19 patients of the ileostomy. The median times since surgery were similar: 41 vs. 43 months	BIQ¹ IBDQ¹¹ SF-36¹⁷
Carmon et al. (2003) [31]	Evaluation of functional outcome and QoL in patients undergoing IPAA, assessment of the correlation between functional outcome and QoL, and identification of factors influencing functional outcome and QoL in these patients	SF-36¹⁷	The results were compared with published norms for the general Israeli population. There was no significant difference between both of the groups. Scores slightly but significantly lower than those of the general population were recorded in the following scales: vitality, social functioning, and role-emotional. Patients with UC after IPAA experienced excellent QoL and acceptable functional outcome
Carmon et al. (2003) [31]	99 patients – Israeli population (35: M, 64: F); median follow-up time was 4.25 years (range: 3 months to 11 years) with UC. Surgery was performed in one stage in 21 (27.3%) patients, two stages in 52 (67.5%) patients, and three stages in 4 (5.2%) patients. The median interval between the first operation and closure of ileostomy was 3 months (range: 0–17 months)	SF-36¹⁷
Scarpa et al. (2004) [32]	Evaluation of the long-term HRQL among UC patients and its modifications after 5-year follow-up. Identification of the risk factors for a worse outcome	IBDQ¹¹	RPC patients, after long-term follow-up, had an HRQoL similar to that of the remission/mild UC patients. Recently operated patients improved their QoL mainly because of improved emotional function. Patients who had been operated on for a longer time maintained their HRQoL. HRQoL was influenced by drugs, stool frequency, pouchitis, postoperative pelvic complications, and age at diagnosis
Scarpa et al. (2004) [32]	Patients submitted to RPC (n = 36; mean age: 40 ±11 years, M: 27). Ulcerative colitis (UC) patients (n = 36; mean age: 41 ±14 years, M: 20). Healthy subjects (n = 36; mean age: 41 ±14 years, M: 20)	IBDQ¹¹
Thaler et al. (2005) [33]	Assessment of the QoL in patients after laparoscopic and open surgery: ileocaecal resection with primary anastomosis for CD patients	GIQLI⁸ SF-36¹⁷	QoL is significantly reduced in patients with CD at long-term follow-up after both laparoscopic and open surgery. Recurrence is the only factor adversely affecting QOL of CD patients in remission irrespective of the operative technique applied
Thaler et al. (2005) [33]	37 patients with a mean age of 48.8 ±18.4 years (n = 23 females and 14 males) were evaluated at a mean follow-up of 42.6 ±25.8 months (minimum of 8 months). N = 21 (57%) patients underwent laparoscopic resection and n = 16 (43%) open surgery	GIQLI⁸ SF-36¹⁷
Nessar et al. (2006) [34]	Evaluation of long-term outcomes for patients undergoing Kock continent ileostomy, finding factors associated with adverse outcomes and comparison of changes in QoL after removal of the reservoir	CGQL²	QoL for patients with CI was higher on all scales in comparison with patients who had the Kock reservoir. Complications were common among CI patients
Nessar et al. (2006) [34]	Patients with continent ileostomy (CI) (n = 181) vs. patients who underwent removal of the continent ileostomy and conversion to an end ileostomy (EI) with Kock reservoir (n = 35); median patient follow-up 11 years (range: 1–27)	CGQL²
Scarpa et al. (2007) [35]	Evaluation of long-term health-related quality of life (HRQoL) outcome and its clinical predictors in CD patients who have had ileocolonic resection	CGQL² CDAI⁴ PIBDQL¹³	CD patients who have undergone ileocolonic resection having an apparently normal quality of life with a good energy level, their long-term HRQoL is still affected by a significantly impaired quality of health. The PIBDQL questionnaire showed significant impairment of bowel and systemic symptom domains with important consequences for social functions and emotional
Scarpa et al. (2007) [35]	97 CD patients, with a mean follow-up of 47.1 months (95% CI: 40.7–53.5 months) after ileocolonic resection, were interviewed by telephone. Control group: 69 healthy	CGQL² CDAI⁴ PIBDQL¹³
Luiz et al. (2009) [36]	Assessment of the quality of life of UC patients who have undergone proctocolectomy with ileal J-pouch-anal anastomosis over 10 years ago, ulcerative colitis patients who underwent proctocolectomy with ileal pouch-anal anastomosis over ten years before being included into the study	IBDQ¹¹	Most of the studied patients presented a high score in the QoL questionnaire. The question pleased and thankful for patients’ personal life received the highest score in the questionnaire. The possibility of sphincter preservation should always be considered because patients remain clinically stable and had a good QoL even after a long period post-operation
Luiz et al. (2009) [36]	Study group: n = 36, M: 38.9%, the average and median ages were 45 and 44 years, respectively, while ages ranged from 28 to 64 years old	IBDQ¹¹
Wade et al. (2009) [37]	Determination of whether there are any differences in QoL between patients who had the J pouch and those who had the W pouch	RFIPC¹⁶	The J-pouch configuration is technically less demanding. It results in similar QoL when compared to the W pouch. The J pouch should be the preferred choice
Wade et al. (2009) [37]	30 patients received a J-pouch and 19 a W-pouch	RFIPC¹⁶
da Luz Moreira et al. (2010) [38]	Determination of the fate of the rectum, functional results, and QoL after IRA in UC	CGQL²	Patients with IRA had fewer bowel movements, less night-time seepage, and increased urgency in comparison with patients with IPAA. QoL was similar in both of the studied groups’ methods; IRA is inferior to IPAA because of dietary and work restrictions
da Luz Moreira et al. (2010) [38]	22 patients suffering from UC with IRA vs. 66 IPA, median follow-up was 9 years (range: 1–36 years)	CGQL²
Somashekar et al. (2010) [39]	Assessment of the functional outcome and QoL after sphincter-saving operations for UC among Indian patients	CGQL²	The mean preoperative CGQL was significantly lower in IPAA patients in comparison with the permanent ileostomy patients. After the procedure it improved, but the magnitude of change was greater among patients undergoing IPAA
Somashekar et al. (2010) [39]	31 Indian (M: 20, F: 11, mean age: 38, range: 20–62 years) patients with UC after restorative proctocolectomy followed-up for 4–6 years; all of these patients had a hand-sewn J-pouch IPAA; 6 Indian (M: 4, F: 2, mean age: 45, range: 36–52 years) patients with UC within 6 months of the subtotal colectomy had not undergone J-pouch IPAA, and thus had permanent ileostomy	CGQL²
Røkke et al. (2011) [40]	Evaluation of the early and long-term surgical and functional results of IPAA in patients with intractable UC	SF-36¹⁷	The functional results in the early follow-up (1993) were remarkably similar to the results 9 years later (2002), with no significant differences in any of the questions. These findings indicate that the results after an “adaption period” will remain unchanged
Røkke et al. (2011) [40]	134 consecutive Norwegian patients (77 men (57.5%), and 57 women (42.5%), mean age: 42.8 years (range: 17–72 years)), with UC treated with restorative proctocolectomy and IPAA. Follow-up 7.4 years after W-ileal pouch (n = 9); J-ileal pouch construction (n = 125). In the first 44 patients, two follow-ups were performed: early follow-up was 2.5 years (range: 0.8–6.7 years) and late follow-up (9 years later) was 11.5 years (range: 8.2–19.2 years)	SF-36¹⁷
Heikens et al. (2012) [41]	Evaluation of the QoL and health status after IPAA in UC patients and comparison of the QoL between reference data from a healthy population	RAND-36¹⁵ WHOQOL-100²²	QoL increased after IPAA and reached levels comparable with those of healthy reference population in the majority of domains and dimensions. QoL was restored first after IPAA, followed by health status
Heikens et al. (2012) [41]	30 patients after IPAA (J-pouch) (M: 12). Evaluation: before and after operation: 6, 12, 24, 36 months	RAND-36¹⁵ WHOQOL-100²²
de Tilio et al. (2013) [42]	Evaluation of QoL in patients with IPAA for UC after at least 1 year postoperatively	IBDQ¹¹	In all domains assessed, patients with IPAA for UC had QoL classified as regular. Ileostomy and lack of professional activity negatively influenced QoL. There was a tendency to lower scores in elderly patients
de Tilio et al. (2013) [42]	Patients (n = 31), mean age: 46.4 years, females (n = 16), postoperative time greater than 10 years in 71% of studied patients	IBDQ¹¹
Heikens et al. (2013) [43]	Evaluation of two surgical methods among UC patients: restorative surgery after (procto)colectomy with ileo-neorectal anastomosis (INRA) and restorative proctocolectomy with ileal pouch-anal anastomosis (RPC)	RAND-36¹⁵ WHOQOL-100²²	Comparison of INRA and RPC on an intention to treat basis was not considered to be realistic because of the high intra-operative conversion rate and the failures in the INRA group (n = 21)
Heikens et al. (2013) [43]	INRA group; n = 71, M: 29, median age: 32.3 years, duration of follow-up 6.2 years. RPC group; n = 71, M: 29, median age: 35.1 years, duration of follow-up 6.9 years. During the study a subgroup of successful INRA patients (n = 50) was created	RAND-36¹⁵ WHOQOL-100²²
Salehimarzijarani et al. (2013) [44]	Evaluation of the QoL in UC patients who underwent IPAA over 5 years ago	IBDQ¹¹	Long-term QoL was good in the study group. In the social area, the questions concerning the working ability and sexual activity received the lowest and the highest scores, respectively. Moreover, physical disposition received the lowest scores, contrary to the satisfaction of personal life with the highest scores
Salehimarzijarani et al. (2013) [44]	Iranian patients with UC (n = 39) average age 37 (range: 18–63 years), after IPAA, categorised into two different age groups: older (25.6%) and younger (74.4%) than 45 years	IBDQ¹¹
Burisch et al. (2014) [45]	Assessment of the impact of treatment choices on HRQoL among patients UC and CD, across Eastern and Western Europe	SF-12¹⁸ SIBDQ¹⁹	Surgical and pharmacological treatment improved HRQoL during the first year of disease. Most of the IBD patients in Eastern and Western Europe had a high perception of HRQoL according disease-specific scale. Biological treatment improved HRQoL in CD patients; UC patients in need of surgery or biological therapy had lower perceptions of HRQoL than other patients
Burisch et al. (2014) [45]	This study was a prospectively collected, unselected population- based inception cohort of 1079 IBD patients, recruited from 30 medical centres from Eastern and Western Europe (n = 402 CD patients, n = 575 UC patients, n = 102 IBDU). 74 patients after surgery	SF-12¹⁸ SIBDQ¹⁹
Meijs et al. (2014) [46]	Comparison of the HRQoL and disability in UC patients after restorative proctocolectomy with ileal pouch-anal anastomosis and in remission with anti-TNF agents – surgery treatment group (RPC with ICA): – 29 patients (median age: 42 years, 48% female); the pouch had to be functional for ≥ 1 year, without postoperative complications; – medically (anti-TNF agents) induced clinical remission group: 29 patients (mean age 45 years, 65% female), treated for ≥ 1 year	EORTC⁵ COREFO³ SF-36¹⁷ WPAI:UC²³	HRQoL and disability outcomes did not differ among UC patients who were in remission following treatment with anti-TNF agents or after proctocolectomy with ileo pouch-anal anastomosis, except for stool frequency and anti-diarrhoea medication use, which were significantly higher in the surgery treatment group
Koerdt et al. (2014) [47]	Comparison of the QoL among patients after IPAA and healthy controls and identification of the specific factors that may have detrimental effects on QoL in IPAA patients	CGQL² GIQLI⁸ FIQLS⁷ IBDQ¹¹ SF-36¹⁷	Overall HRQoL after IPAA was good. However, high stool frequency, faecal incontinence and pouchitis were associated with impaired QoL
Koerdt et al. (2014) [47]	48 patients (M: 32); median age 38 years; median follow-up 57 months after IPAA. 48 matched controls	CGQL² GIQLI⁸ FIQLS⁷ IBDQ¹¹ SF-36¹⁷
Kozłowska et al. (2014) [48]	35 patients with UC were treated surgically 3 months after surgery	IBDQ¹¹ SF-36¹⁷	The objective IBDQ scale showed better quality of life in UC patients treated surgically than the subjective SF-36 scale

BIQ (Body Image questionnaire (BIQ): 19 items: general body satisfaction, assessment of body image satisfaction and dissatisfaction by measuring the degree of discrepancy self-esteem and idealised physical characteristics, and taking into account the valence or physical significance of each of the ideals to the person;

CGQL (Cleveland Global Quality of Life Instrument): 47 questions; 4 dimensions: medical symptoms, functional performance, social, life.

COREFO (Colorectal Functional Outcomes Questionnaire): 27 questions, 5 dimension: faecal incontinence, social impact, stool frequency, stool related aspects and need for anti-diarrhoea medical use.

⁴

CDAI (Crohn’s Disease Activity Index); eight factors: number of liquid or soft stools, abdominal pain, general wellbeing, presence of complications, taking lomotil or opiates for diarrhoea, presence of an abdominal mass, haematocrit, percentage deviation from standard weight.

⁵

EORTC (European Organisation for Research and Treatment of Cancer); 6 items: sexual functioning, sexual enjoyment, male sexual problems, female sexual problems, skin (itchy or dry), muscle and joint.

⁶

EuroQol: 5 items: 5 dimensions: mobility, personal care, daily activities, pain, anxiety/depression, VAS indicating health status.

⁷

FIQLS (Faecal Incontinence Quality of Life Scale); 29 questions; 4 domains: lifestyle, coping/behaviour, depression/self-perception, embarrassment.

⁸

GIQLI (Gastrointestinal QoL Index): 36 questions 5 dimensions: physical function, emotional status, social function, gastrointestinal symptoms and distress by medical treatment.

⁹

HADS (Hospital Anxiety and Depression); 14 questions: 2 dimensions: anxiety, depression.

¹⁰

HSQ (Health Status Questionnaire): 39 questions; 8 dimensions: a general health perception, physical functioning, physical role limitations (the interference with work by physical health), emotional role limitations (interference with work by emotional problems), social functioning, mental health, bodily pain, and energy/vitality.

¹¹

IBDQ 36 (Inflammatory Bowel Disease Questionnaire-36): 36 questions; 5 dimensions: bowel, systemic, social, emotional, systemic symptoms.

¹²

Öresland scale – questions regarding health care utilization and medication use.

¹³

PIBDQL (Padova Inflammatory Bowel Diseases): 29 items intestinal symptoms (eight questions; systemic symptoms (seven questions, emotional function (nine questions; social function (five questions).

¹⁴

PGWB (Psychological General well- being): 22 questions: subjective general well-being.

¹⁵

RAND 36 (RAND 36-Item Health Survey): 36 questions; 8 dimensions: physical functioning, bodily pain, role limitations due to physical health problems, role limitations due to personal or emotional problems, general mental health, social functioning, energy/fatigue, general health perceptions.

¹⁶

RFIPC (Rating Form of Inflammatory Bowel Disease Patient Concerns): 25 questions; 4 dimensions: disease, body, interpersonal, sexual.

¹⁷

SF-36 (Short Form 36): 36 questions, 8 dimension: physical functioning, social functioning, role limitations due to physical and emotional problems, mental health, energy and vitality, body pain and general health perception.

¹⁸

SF-12 (Short Form12): 12 questions, 8 dimension: physical functioning, social functioning, role limitations due to physical and emotional problems, mental health, energy and vitality, body pain and general health perception.

¹⁹

Short IBDQ (Short Inflammatory Bowel Disease Questionnaire-12): 10 questions, 4 dimension: bowel, systemic, social, emotional.

²⁰

TTO (Time Trade-off Technique): questions used to assess the patients’ and carers’ quality of life, before and after intervention.

²¹

VAS; visual analogue scale for subjective characteristics or attitudes that cannot be directly measured.

²²

WHOQOL-100 (World Health Organization Quality of Life-100): 100 questions, 5 dimension: role physical, general health, social functioning, mental health, vitality.

²³

WPAI:UC (Work Productivity and Activity Impairment in UC): 6 questions; four items: absenteeism, presenteeism, activity impairment, overall impairment.