Health-related quality of life and gastrointestinal disease

Health-related quality of life and cognitive function in children with Crigler-Najjar syndrome type 1

BACKGROUND

The aim of the study was to assess the health-related quality of life (HRQOL) and cognitive function in patients with Crigler-Najjar syndrome (CNS) type I and its impact on their lives.

METHODS

Twenty-one patients diagnosed with CNS type I aged 1 month to 18 years in the Paediatric Hepatology Unit of Cairo University Children's Hospital were enrolled in this cross-sectional observational study. The patients' health-related quality of life (HRQOL) was assessed using the World Health Organization Quality Of Life BREF questionnaire (WHOQOL-BREF) and the Short Form 36 Health Survey Questionnaire (SF-36). Cognitive function was assessed using the Stanford-Binet Intelligence Scale: Fifth Edition (SB5).

RESULTS

All patients had a history of admission to a neonatal intensive care unit, 17 were managed by phototherapy only and 5 also underwent exchange transfusion. According to the WHOQOL questionnaire, 11 cases (52.4%) had a low QOL score, and 7 of 13 patients had an average score for their total IQ test. Cases with poor compliance to phototherapy had statistically significantly lower QOL scores (p=0.001), while, according to the SF36 survey, cases who received exchange transfusion had statistically significantly higher cognitive function (p=0.03). There was a positive correlation between the neurological effect as a complication of the disease and poor physical QOL.

CONCLUSION

Paediatric patients with CNS have significantly lower HRQOL, especially physically, psychologically and environmentally. It is recommended that assessment of HRQOL should be a routine part of follow-up in CNS patients. Patients whose HRQOL is affected receive regular psychiatric counselling, social support and rehabilitation.Abbreviations: CNS: Crigler-Najjar syndrome; HRQOL: health-related quality of life; IQ: intelligence quotient; NICU: neonatal intensive care unit; QOL: quality of life; SB5: Stanford-Binet intelligence scale: 5th edition; SF-36: Short Form 36 Health Survey Questionnaire; UDGT: uridine diphosphate glucuronosyl transferase; UGT1A1: uridine 5'-diphosphate glucuronosyltransferase; WHOQOL-BREF: World Health Organization Quality of Life Brief Version.

Health-related quality of life among celiacs in Portugal: a comparison between general and specific questionnaires

Objective

This study aimed to compare the 36-Item Short Form Survey Instrument version 2 (SF-36-v2) (generic) and Celiac Disease Questionnaire (CDQ) (specific) questionnaires used to evaluate the quality of life (QoL) in celiac Portuguese adult individuals.

Methods

This cross-sectional study used non-probabilistic sampling based on Portuguese celiac patients who accessed the online survey in 2022. The online data collection used a self-reported instrument composed of three parts: (i) socioeconomic, health, and gluten-free diet (GFD) adherence questions; (ii) SF-36 v2 - Portuguese version (generic questionnaire) and (iii) Celiac Disease Questionnaire (CDQ) (specific questionnaire).

Results

A total of 234 individuals who accessed the survey completed the questionnaire. Seven of the eight SF-36 domains positively correlated to the specific questionnaire CDQ. The "General Health" domain (domain 4) showed a negative correlation with the CDQ. Differences in content between the two instruments might be able to explain this finding since the CDQ explores issues regarding the specificities of celiac disease (CD) and the lifelong GFD burden. About half of the sample from this study displayed poor diet adherence, it is possible that the SF-36 could not reflect the impact of CD treatment - the complete elimination of gluten from the diet - on patients' health. Therefore, this issue should be carefully evaluated in future research.

Conclusion

Specific validated questionnaires for CD individuals, such as the CDQ, contemplate social, economic, and clinical variables that permeate the patient's life context. Therefore, these instruments may be more suitable for evaluating QoL in this public. However, using a general questionnaire such as the SF-36 would be indicated for comparing QOL between celiac patients and the general population or even between CD and other disease individuals. In this case, we recommend assessing GFD compliance for control parallelly.

Diabetic Gastroparesis and its Emerging Therapeutic Options: A Narrative Review of the Literature

Diabetic gastroparesis (DG) is one of the many complications of diabetes mellitus (DM). Even though this condition surfaces years after uncontrolled disease, it affects the quality of life in several ways and causes significant morbidity. Common symptoms experienced by the patients include postprandial nausea, vomiting, abdominal fullness, and pain. Strict glycemic control is essential to evade the effects of DG. The purpose of this review article is to briefly study the pathophysiology, clinical features, diagnostic modalities, and the effects of DG on different aspects of life. Furthermore, it also focuses on the emerging treatment modalities for DG. Tradipitant and relamorelin are two such treatment options that are gaining noteworthy recognition and are discussed in detail in this review article. As observed through various clinical trials, these drugs help alleviate symptoms like nausea, vomiting, abdominal pain, and bloating in patients suffering from DG, thereby targeting the most common and bothersome symptoms of the disease. This leads to an improvement in the quality of life, making it a reliable treatment option for this disease. But while pharmacological intervention is vital, psychological support and lifestyle changes are equally important and are the reason why a multidisciplinary approach is required for the treatment of DG.

Pelvic floor physical therapy in the treatment of chronic anal fissure (PAF trial): quality of life outcome

BACKGROUND

Chronic anal fissure is one of the most common anorectal diseases and is associated with reduced quality of life. The aim of this study was to investigate the effects of pelvic floor physical therapy on quality of life in patients with chronic anal fissure using the Short-Form 36 Health Survey (RAND-36).

METHODS

Adult patients, with chronic anal fissure and concomitant pelvic floor dysfunction, such as dyssynergia and increased pelvic floor muscle tone, were recruited at the Proctos Clinic in the Netherlands, between December 2018 and July 2021 and randomly assigned to an intervention group, receiving 8 weeks of pelvic floor physical therapy or assigned to a control group receiving postponed pelvic floor physical therapy (PAF trial). Quality of life and pain ratings were outcomes of the study and were measured at 8- and 20-week follow-up.

RESULTS

One hundred patients (50 women and 50 men, median age 44.6 years [range 19-68 years]), completed the RAND-36 questionnaire and visual analog (VAS) pain scale score at admission. A significant improvement was found at 20-week follow-up in all domains of the RAND-36; physical functioning, pain, health change (p < 0.001); physical role, vitality, general health, social functioning, emotional role, mental health (p < 0.05). VAS pain was significantly reduced at 8 weeks (mean estimated difference 1.98; 95% CI 1.55-2.42, p < 0.001) and remained significant at 20-week follow-up (p < 0.001). The difference between the groups as regards change in the mean pain intensity scores at 8 weeks was 2.48 (95% CI - 3.20 to - 1.75; p < 0.001). Compared to the reference values of the general Dutch population, the patients in our study with a chronic anal fissure and pelvic floor dysfunction reported an impaired quality of life in 8 of 9 domains of the RAND-36. After treatment, significant lower scores were found in 2 out of 9 domains.

CONCLUSIONS

The results of this study provide evidence that treatment by pelvic floor physical therapy improves quality of life and reduces pain, making it an important tool in management of chronic anal fissure and concomitant pelvic floor dysfunction.

Differences in patient outcomes after outpatient GI endoscopy across settings: a statewide matched cohort study

BACKGROUND AND AIMS

Outpatient GI endoscopy has been shifting from hospital outpatient departments (HOPDs) to ambulatory surgery centers (ASCs) in recent years. However, evidence on whether patient outcomes after endoscopic procedures are comparable across settings is limited. This study compares the incidence of unplanned hospital visits after GI endoscopy performed in ASCs versus HOPDs.

METHODS

We conducted a retrospective cohort study examining unplanned hospital visits after outpatient GI endoscopy performed in Massachusetts during 2014 to 2017 using Massachusetts All-Payer Claims Database and Medicare fee-for-service claims. We identified screening colonoscopy, nonscreening colonoscopy, and esophagogastroduodenoscopies (EGDs) performed in ASCs or HOPDs and estimated unplanned hospital visit rates within 7 and 30 days after these procedures. To compare rates between ASCs and HOPDs, we constructed procedure-specific, propensity score-matched samples and used multilevel logistic regressions adjusting for patient, procedure, and facility characteristics.

RESULTS

Seven-day unplanned hospital visit rates were 10.6, 18.3, and 38.9 per 1000 procedures for screening colonoscopy, nonscreening colonoscopy, and EGD, respectively, with significant variation across facilities. ASC patients consistently had fewer postprocedure hospital encounters. The relative risk of having 7-day hospital visits after screening colonoscopy performed in ASCs was .88 (95% confidence interval [CI], .79-.98) compared with HOPDs. The estimates were .84 (95% CI, .75-.94) for nonscreening colonoscopy and .57 (95% CI, .50-.65) for EGD. Thirty-day visits showed similar patterns.

CONCLUSIONS

Unplanned hospital visits after outpatient GI endoscopy were not uncommon. However, ASC patients consistently had less frequent hospital-based acute care encounters, indicating that GI endoscopy could be performed safely in ASCs for select patients.

Differences between expert reported and patient reported burden of disease rankings

Many attempted to develop burden of disease rankings for the purpose of resource allocation, priority setting, cost-effectiveness evaluation, and service development in healthcare. As this proved difficult the World Health Organization commissioned expert panels to develop internally consistent burden of disease rankings. Although these rankings provide valuable insight in the biomedical burden of different diseases, they do not yet provide insight in the psychological burden of different diseases experienced and reported by patients on a daily basis. Since expert reported and patient reported burden of disease could differ, deviations between expert reported and patient reported burden of disease rankings are likely. To explore how these rankings differ, it is important to develop patient reported burden of disease rankings and compare these to expert reported burden of disease rankings. In this study patient reported burden of disease rankings were developed by ranking the subjective health experience of patients. To measure subjective health experience an online questionnaire was administered to a large panel of Dutch citizens. The final sample consisted of 58,490 panel members. This final sample contained 36 diseases and was largely representative of the Dutch population. The data were analysed by using reliability tests, descriptive statistics and Spearman rank-order correlation coefficients. This study shows that expert reported and patient reported burden of disease rankings could differ. Burden of cardiovascular diseases ranks low on patient reported burden of disease rankings, while it ranks higher on expert reported burden of disease rankings. Burden of psychiatric diseases and gastrointestinal diseases ranks high on patient reported burden of disease rankings, while it ranks lower on expert reported burden of disease rankings. Burden of pain diseases ranks high on patient reported burden of disease rankings, while it is still overlooked in expert reported burden of disease rankings. This study suggests that it can be beneficial to develop and utilize patient reported burden of disease rankings in addition to the already existing expert reported burden of disease rankings in order to establish a more comprehensive perspective on burden of disease. This could improve decision-making on resource allocation, priority setting, cost-effectiveness evaluation, and service development in healthcare.

Implementation and assessment patient cases using the SBAR method to teach patient quality of life issues

BACKGROUND AND PURPOSE

Quality of life (QoL) preferences are an important consideration with respect to the Pharmacists' Patient Care Process (PPCP) and should be assessed prior to implementing a patient-centered plan. The objectives of this intervention were to determine if the design of a QoL activity impacts student performance, and to discern student perceptions of an innovative, case-based activity.

EDUCATIONAL ACTIVITY AND SETTING

Two cohorts of students in their second professional year were asked to present an article that included a QoL consideration. The two student cohorts were asked to complete the activity using a case report and modified SBAR (Situation, Background, Assessment, Recommendation) format. Presentations were graded using a rubric, and scores were assessed retrospectively. An unpaired t-test was used to examine differences. The final cohort of students was also asked to complete a survey to gather their perspectives. Results were described using descriptive statistics; thematic analyses were also performed.

FINDINGS

Students who completed the SBAR activity (N = 71) performed significantly better than those who completed the article (N = 98) presentation (95.62 ± 5.47 vs. 86.30 ± 16.54, P < .001). Those who completed the survey (N = 22) felt they made moderate to excellent progress explaining QoL (86%) and that the activity was helpful (68%). Overall, students reported an improved understanding of the patient's perspective.

SUMMARY

The PPCP requires that students must consider the patient's QoL in order to develop an optimal patient-centered plan. Activities such as this may improve student understanding of QoL implications.

Brazilian-Portuguese Validation Assessment of the Gastrointestinal Quality of Life Index for Patients After Laparoendoscopic Cholecystectomy

Background: Cholelithiasis is currently one of the most common diagnosis in Brazil. The aim of this study was to validate the Gastrointestinal Quality of Life Index (GIQLI) as a quality-of-life (QoL) assessment among the Brazilian population with syntomatic gallstone. Materials and Methods: The questionnaire was translated and culturally adapted after the linguistic validation process determined by the international methodology. Sixty-three patients who underwent laparoscopic cholecystectomy responded to the GIQLI-Brazil and Short-Form Health Survey (SF-36) instruments. For the evaluation of reproducibility, 30 patients responded to GIQLI-Brazil two more times after 2 and 4 weeks. After the University of São Paulo Ethics Commitee Board approval (UNIFESP/CEP: 1270/2019), the study was carryed out between May 2019 and February 2020 at the Gastroenterology outpatient clinic of Hospital São Paulo-Federal University of São Paulo (UNIFESP). Cronbach's alpha, the calculation of the intraclass correlation coefficient (ICC), and Spearman's correlation were used to assess the validity and reproducibility of the instrument translated into Portuguese, and to measure correlation between the domains of the GIQLI-Brazil and SF-36 (P < .05). Results: Seven questions were modified during the process of translation and cultural adaptation. The Brazilian version of the instrument presented a Cronbach's alpha of 0.89, and excellent reproducibility through the ICC, with the following variation between domains: meteorism (ICC = 0.918; P < .001) and gastrointestinal function (lower tract) (ICC = 0.956; P < .001). The dimensions of the GIQLI-Brazil and SF-36 demonstrated a significant correlation (P < .001), except between the domains: functional aspects of the SF-36 and gastrointestinal function (lower tract) of the GIQLI-Brazil (r = 0.211). Conclusion: The GIQLI was translated and validated for Portuguese-Brazil and can be used to assess the QoL of adult patients with gastrointestinal diseases and/or disorders.

Health-related quality of life in Malaysian gastrointestinal cancer patients and their family caregivers-a comparison study

PURPOSE

Gastrointestinal (GI) cancer has emerged as a major health problem. Cancer patients receive informal care from their families beyond formal care. There has been little evidence showing how the health-related quality of life (HRQOL) of the caregivers differs from that of the GI patients in Malaysia. A cross-sectional study was conducted in three referral hospitals in Malaysia. The objectives of this study were to determine the HRQOL of GI cancer patients and their family caregivers, and assess whether there is any significant relationship between the demographic factors, and the physical component summary (PCS) and mental component summary (MCS) scores for patients and caregivers.

METHODS

A total of 323 dyads of GI cancer patients and their caregivers completed the Medical Outcomes Study 12-item Short Form (MOS SF-12) questionnaire to measure their HRQOL during face-to-face interviews. The analyses were performed using SF-12 scoring software to compute PCS and MCS scores (HRQOL parameters). The independent t test, one-way ANOVA, and the Pearson correlation test were conducted to determine the demographic factors related to the HRQOL of the dyads.

RESULTS

The caregivers had higher scores in all domains for the SF-12 than the patients. There were significant differences found in the MCS scores of the patients according to ethnicity, origin of cancer, duration of cancer, and surgery. None of these factors had a significant relationship with the caregivers' HRQOL.

CONCLUSION

Caregivers had better HRQOL than cancer patients. Early intervention for cancer patients in the form of counselling and personalised pain management may enhance the HRQOL of patients.

Perceived stress and inappropriate coping behaviors associated with poorer quality of life and prognosis in patients with ulcerative colitis

OBJECTIVE

To explore the effect of perceived stress and coping behaviors on quality of life and clinical outcomes in patients with ulcerative colitis.

METHODS

This is a prospective cohort study in a tertiary inflammatory bowel disease center in China. A total of 263 ulcerative colitis patients were enrolled consecutively between June 2013 and February 2015. The Perceived Stress Scale, the Medical Coping Modes Questionnaire, and the Inflammatory Bowel Disease Questionnaire were used to assess perceived stress, medical coping and quality of life at baseline. Patients were followed up for hospitalization due to relapse over a one-year period. Multivariate analyses were performed to identify whether perceived stress and medical coping behavior were related to quality of life and hospitalization.

RESULTS

Patients with invalid questionnaires (n = 6) and those lost to follow-up (n = 28) were excluded. A total of 229 ulcerative colitis patients (mean age 40.4 ± 12.6, 50.7% male) were included in the final analysis, and 23 patients had been hospitalized during the one-year follow-up period. After adjusting other associated variables, perceived stress (OR: 1.13; 95% CI: 1.07 to 1.19) and acceptance-resignation behavior (OR: 1.41; 95% CI: 1.21 to 1.65) were independently associated with poor quality of life. Patients scoring highly for acceptance-resignation behavior (OR: 1.23; 95% CI: 1.04 to 1.46) were more likely to be hospitalized during the one-year follow-up period.

CONCLUSION

In patients with ulcerative colitis, identifying those who adopted more acceptance-resignation behavior and improving their medical coping behavior by psychotherapy could be helpful to achieve better quality of life and disease control.

Assessment of Validity of SF 36 Questionnaire Using Nepali Language to Determine Health-related Quality of Life in Patients with Chronic Liver Disease: A Pilot Study

OBJECTIVES

The main objective of this study was to translate and validate the short form 36 (SF-36) health survey questionnaire into the Nepali language using a standard protocol to determine health-related quality of life (HRQoL) in patients with chronic liver disease (CLD).

METHODS

We conducted a cross-sectional study among 40 patients with CLD. A formal translation of SF-36 from English into the Nepali language was performed. Patients with CLD without other known co-morbidities were administered the Nepali version of SF-36. Cronbach's alpha and test-retest were performed for reliability analysis.

RESULTS

Cronbach's alpha of overall SF-36 score was 0.85, and the test-retest correlation coefficient was 0.78 (p <0.05).

CONCLUSION

The Nepali language version of SF-36 is valid and reliable.

Factors associated with health-related quality of life in patients with functional dyspepsia

BACKGROUND

Health-related quality of life (HRQoL) assessment is important for patients with functional dyspepsia. However, no studies have assessed factors associated with HRQoL reduction in such patients in an Asian population. This study aimed to determine the contribution of clinical, psychosocial, and demographic factors to HRQoL in affected patients in Indonesia.

METHODS

In a cross-sectional study, we recruited 124 patients in a tertiary hospital with functional dyspepsia according to Rome III criteria. HRQoL was measured using the Medical Outcomes Study Short-Form 36 (SF-36) physical component summary (PCS) and mental component summary (MCS) and compared with 2009 United States population norms. The factors investigated were age, gender, symptom severity, education level, employment status, anxiety, depression, and ethnicity. Factors associated with reduced HRQoL were identified using linear regression analysis.

RESULTS

All domains of HRQoL except vitality were impaired in patients with functional dyspepsia. The mean PCS was 42.3 (SD = 8.4); and the mean MCS was 47.8 (SD = 10). Increasing age (p = 0.002), female gender (p = 0.006), low-to-mid education level (p = 0.015) and greater symptom severity (p < 0.001) were significantly associated with impaired PCS (R2 = 0.36). Female gender (p = 0.047), greater symptom severity (p = 0.002), anxiety (p = 0.001), and depression (p = 0.002 were all significantly associated with an impaired MCS (R2 = 0.41). There were no significant associations between HRQoL and with ethnic group (Javanese/non-Javanese) or employment status.

CONCLUSIONS

There was significant HRQoL impairment in these patients with functional dyspepsia in Indonesia. Anxiety, depression, increasing age, female gender, greater symptom severity, and low-to-mid education level were significant factors associated with low HRQoL.  TRIAL REGISTRATION: ClinicalTrials.gov NCT03321383 . Registered 18 October 2017 retrospectively registered.

Factors associated with health-related quality of life in patients with functional dyspepsia

BACKGROUND

Health-related quality of life (HRQoL) assessment is important for patients with functional dyspepsia. However, no studies have assessed factors associated with HRQoL reduction in such patients in an Asian population. This study aimed to determine the contribution of clinical, psychosocial, and demographic factors to HRQoL in affected patients in Indonesia.

METHODS

In a cross-sectional study, we recruited 124 patients in a tertiary hospital with functional dyspepsia according to Rome III criteria. HRQoL was measured using the Medical Outcomes Study Short-Form 36 (SF-36) physical component summary (PCS) and mental component summary (MCS) and compared with 2009 United States population norms. The factors investigated were age, gender, symptom severity, education level, employment status, anxiety, depression, and ethnicity. Factors associated with reduced HRQoL were identified using linear regression analysis.

RESULTS

All domains of HRQoL except vitality were impaired in patients with functional dyspepsia. The mean PCS was 42.3 (SD = 8.4); and the mean MCS was 47.8 (SD = 10). Increasing age (p = 0.002), female gender (p = 0.006), low-to-mid education level (p = 0.015) and greater symptom severity (p < 0.001) were significantly associated with impaired PCS (R² = 0.36). Female gender (p = 0.047), greater symptom severity (p = 0.002), anxiety (p = 0.001), and depression (p = 0.002 were all significantly associated with an impaired MCS (R² = 0.41). There were no significant associations between HRQoL and with ethnic group (Javanese/non-Javanese) or employment status.

CONCLUSIONS

There was significant HRQoL impairment in these patients with functional dyspepsia in Indonesia. Anxiety, depression, increasing age, female gender, greater symptom severity, and low-to-mid education level were significant factors associated with low HRQoL.  TRIAL REGISTRATION: ClinicalTrials.gov NCT03321383 . Registered 18 October 2017 retrospectively registered.

Gastrointestinal Symptom Distress is Associated With Worse Mental and Physical Health-Related Quality of Life

BACKGROUND

The prevalence of self-reported gastrointestinal (GI) symptoms and distress is high, but few studies have quantified their impact on health-related quality of life (HRQoL).

METHODS

We conducted a prospective cohort study of patients with HIV in care in Ontario, Canada (2007-2014). General linear mixed models were used to assess the impact of GI symptoms (diarrhea/soft stool, nausea/vomiting, bloating/painful abdomen, loss of appetite, weight loss/wasting) and distress (range: 0-4) on physical and mental HRQoL summary scores (range: 0-100) measured by the Medical Outcomes Survey SF-36.

RESULTS

A total of 1787 participants completed one or more questionnaires {median 3 [interquartile range (IQR): 1-4]}. At baseline, 59.0% were men who had sex with men, 53.7% white, median age 45 (IQR: 38-52), median CD4 count 457 (IQR: 315-622), and 71.0% had undetectable HIV viremia. The mean (standard deviation [SD]) mental and physical HRQoL scores were 49.2 (8.6) and 45.3 (13.0), respectively. In adjusted models, compared with those reporting no symptoms, all GI symptom distress scores from 2 ("have symptom, bothers me a little") to 4 ("have symptom, bothers a lot") were associated with lower mental HRQoL. Loss of appetite distress scores ≥ 1; scores ≥ 2 for diarrhea, nausea/vomiting, and bloating; and a score ≥ 3 for weight loss were independently associated with lower physical HRQoL scores (P < 0.0001). Increasing GI symptom distress is associated with impaired mental and physical HRQoL (P < 0.0001).

CONCLUSIONS

Increasing GI symptom distress is associated with impaired mental and physical HRQoL. Identifying, treating, and preventing GI symptoms may reduce overall symptom burden and improve HRQoL for patients with HIV.

Psychological controversies in gastroparesis: A systematic review

AIM

To systematically review literature addressing three key psychologically-oriented controversies associated with gastroparesis.

METHODS

A comprehensive search of PubMed, CINAHL, and PsycINFO databases was performed to identify literature addressing the relationship between gastroparesis and psychological factors. Two researchers independently screened all references. Inclusion criteria were: an adult sample of gastroparesis patients, a quantitative methodology, and at least one of the following: (1) evaluation of the prevalence of psychopathology; (2) an outcome measure of anxiety, depression, or quality of life; and (3) evidence of a psychological intervention. Case studies, review articles, and publications in languages other than English were excluded from the current review.

RESULTS

Prevalence of psychopathology was evaluated by three studies (n = 378), which found that combined anxiety/depression was present in 24% of the gastroparesis cohort, severe anxiety in 12.4%, depression in 21.8%-23%, and somatization in 50%. Level of anxiety and depression was included as an outcome measure in six studies (n = 1408), and while limited research made it difficult to determine the level of anxiety and depression in the cohort, a clear positive relationship with gastroparesis symptom severity was evident. Quality of life was included as an outcome measure in 11 studies (n = 2076), with gastroparesis patients reporting lower quality of life than population norms, and a negative relationship between quality of life and symptom severity. One study assessed the use of a psychological intervention for gastroparesis patients (n = 120) and found that depression and gastric function were improved in patients who received psychological intervention, however the study had considerable methodological limitations.

CONCLUSION

Gastroparesis is associated with significant psychological distress and poor quality of life. Recommendations for future studies and the development of psychological interventions are provided.

Glucose fluctuations reduce quality of sleep and of life in patients with liver cirrhosis

BACKGROUND

Sleep disturbance and decreased health-related quality of life (HRQOL) are significant complaints in patients with liver cirrhosis. Although the etiology of these complications is unclear, we propose that glucose intolerance may be a predisposing factor. Therefore, our aim was to investigate the relationship between glucose intolerance and these complications.

METHODS

We assessed continuous glucose monitoring in 43 patients with chronic liver disease. Among these patients, 36 completed the Pittsburgh Sleep Quality Index (PSQI), the 36-Item Short-form Health Survey (SF-36), and the Neuropsychological Test (NPT). We also assessed the change in glucose fluctuations between preoperative periods and 1 year after liver transplantation in 13 patients.

RESULTS

Standard deviation (SD) of blood glucose was 24.15 ± 13.52. SD values correlated to glucose metabolism measures, including HbA1c and glycoalbumin. SD values also correlated to markers of liver fibrosis, including type IV collagen. Twenty-one patients (58.3 %) were classified as "poor" sleepers, with a global PSQI score ≥6. Glucose fluctuations correlated with the global PSQI score (r = 0.456, p = 0.008) and the SF-36 score (r = 0.434, p = 0.013). Multivariate regression analysis identified SD values as an independent risk factor for sleep disturbance (r = 0.12, p = 0.039) and decreased HRQOL (r = -0.32, p = 0.024). SD values did not correlate with the NPT. SD values were also improved in 11 (84.6 %) patients 1 year after liver transplantation.

CONCLUSION

Abnormal glucose fluctuations are a risk factor for sleep disturbance and decrease of HRQOL in patients with cirrhosis.

Analysis of the quality of life of patients with asthma and allergic rhinitis after immunotherapy

Aim

To assess the quality of life of Polish patients with asthma and/or allergic rhinitis before the implementation and after 30–36 months of immunotherapy.

Material and methods

Two hundred patients have been involved in the study: 101 with allergic asthma and 99 with pollinosis. In order to collect research material, the Polish versions of AQLQ (Asthma Quality of Life) and RQLQ (Rhinoconjunctivitis Quality of Life) questionnaires have been used. The self-administered questionnaires concerned such data as age, sex and the patients’ subjective evaluation of their quality of life.

Results

The average increase in quality of life of patients with asthma was 0.84 and of patients with allergic rhinitis – 1.50. A hypothesis was made that changes of quality of life in each examined group differed significantly. A test for two fractions showed that for patients with asthma it was 7.74 and for patients with allergic rhinitis – 10.38. A statistical analysis showed no such relation in the group of patients with asthma (coefficient of correlation = 0.08) and a slight correlation in the group of patients with allergic rhinitis (coefficient of correlation = 0.20). Applied tests did not show any significant differences, which means that an average increase in quality of life does not depend on sex and age of both examined groups.

Conclusions

On the basis of the research conducted among patients before and after a 3-year period of immunotherapy, the following conclusions have been drawn: 1) immunotherapy significantly improves the objective quality of life in both groups; 2) a slight correlation has been identified between the objective and subjective dimension of quality of life amongst patients with asthma, what contributes to a better quality of life; 3) in both study groups, no significant relationship between gender or age and improvement in quality of life has been noted; 4) immunotherapy, from the point of view of the improvement of quality of life, is a valuable therapeutic tool in patients with atopic bronchial asthma and allergic rhinitis.

Assessment of health-related quality of life and related factors in patients with chronic liver disease

Background and objectives

Assessing health-related quality of life is an important aspect of clinical practice. Thus, the present study attempts to assess the health-related quality of life of patients with chronic liver disease.

Methods

A cross-sectional survey was conducted on 133 chronic liver disease patients, using three instruments: a demographic questionnaire, the Chronic Liver Disease Questionnaire, and Model for End-Stage Liver Disease index. Variables were expressed as frequencies, percentages, means, and standard deviations. The statistical analysis included Pearson's correlation, Student's t-test, and analysis of variance (p < 0.05 was considered significant).

Results

The mean age of included subjects was 50.5 ± 13.3 years. The majority were male (66.2%), Caucasian (70.7%), and had a family income of US$329–US$658.2. Over half of the patients (56.4%) were infected by hepatitis C virus and 93.2% had low Model for End-Stage Liver Disease scores. Model for End-Stage Liver Disease score was related to age (r = 0.185; p = 0.033). Higher mean Chronic Liver Disease Questionnaire scores were obtained for emotional function (39.70/SD ± 12.98) and while lower scores were obtained for abdominal symptoms (16.00/SD ± 6.25). Fifty-two patients (39.1%) presented overall low (<5) Chronic Liver Disease Questionnaire scores. Furthermore, Chronic Liver Disease Questionnaire score was related to family income (r = 0.187, p = 0.031).

Conclusion

Most individuals presented high mean Chronic Liver Disease Questionnaire scores, indicating low health-related quality of life, especially individuals with low family income.

Health-related quality of life (HRQOL) in children with chronic liver disease in North East Iran using PedsQL™ 4.0

Background:

Health-related quality of life (HRQOL) is a concept that relates to an individual’s perception of health status in relation to the culture and value systems in which they live, in addition to their expectations, goals, concerns, and living standards. Considering the size of the population affected by Chronic Liver Diseases (CLDs) and the severity and chronic nature of the symptoms, there is an emerging need to evaluate the quality of life of patients using a standard protocol. The aim of this study is to assess the HRQOL in children with CLD based on child self-report and parent proxy-report forms.

Methods:

A total of 164 children, 55 CLD and 109 healthy children (aged 6–17 years), upon referral from the Pediatric Department at Ghaem Hospital in Mashhad from 2010 to 2014 were enrolled in this case-control study. We used the PedsQL^TM 4.0 generic score scale to assess the HRQOL in children with CLD compared to the control group based on child self- and parent proxy reports.

Results:

According to the child self-reports, the total HRQOL in the case group (89.93±9.63) was significantly lower than control group (93.05±9.28) (p=0.006). We found significant differences in emotional functioning based on the CLD child self-reports (p=0.001) and their parent proxy-reports (p=0.002). Furthermore, there was a statistically significant correlation between the severity and physical functioning as reported by the Child-Pugh score (p=0.03, r= −0.31) and the MELD/PELD scores (p=0.01, r= −0.35), based on child self-reports. Gender, age of onset, CLD types, duration of the disease, and treatment showed no significant differences with total HRQOL.

Conclusion:

HRQOL is significantly lower in children with CLD in comparison to the normal population. We strongly recommend considering different aspects of quality of life, especially emotional functioning concomitant to the therapy programs.

The impact of type D personality on health-related quality of life in patients with symptomatic haemorrhoids

Introduction

Haemorrhoids are one of the most common reasons that patients seek consultation from a colon and rectal surgeon. Health-related quality of life (HrQoL) is a significant factor in describing the burden of illness and the impact of treatment in patients with gastrointestinal disease. Type D (distressed) personality is defined as the co-occurrence of negative affect and social inhibition.

Aim

To assess the prevalence of type D personality in patients with haemorrhoids and to investigate whether the presence of a type D personality would affect HrQoL in patients with haemorrhoids.

Material and methods

One hundred and six outpatients with symptomatic haemorrhoids with no psychiatric comorbidity were consecutively enrolled, along with 96 healthy controls. The Type D Scale (DS14) and the General Health Survey Short Form-36 (SF-36) were used in the collection of data.

Results

Of 106 patients evaluated, 29.2% met criteria for type D personality. Patients with haemorrhoids scored lower on bodily pain and vitality dimensions of SF-36 than did healthy subjects (p < 0.001). Patients with a type D personality were found to score lower on bodily pain domain of HrQoL than patients without a type D personality. Linear regression analysis revealed a significant independent association of type D personality with bodily pain dimension of the SF-36 in patients with symptomatic haemorrhoids (r = –0.315, p < 0.01).

Conclusions

Type D personality was associated with increased perceived bodily pain in patients with haemorrhoids. Consideration of type D personality construct personality traits could improve risk stratification in research and clinical practice in this patient group.

Health-related quality of life in patients with anal fissure: effect of type D personality

INTRODUCTION

Health-related quality of life (HRQL) is a significant factor in describing the burden of illness and the impact of treatment in patients with gastrointestinal disease. Type D (distressed) personality is defined as the co-occurrence of negative affect and social inhibition.

AIM

To assess the prevalence of type D personality in patients with anal fissure and to investigate whether the presence of a type D personality would affect HRQL in patients with anal fissure.

MATERIAL AND METHODS

One hundred outpatients with anal fissure with no psychiatric comorbidity were consecutively enrolled, along with 100 healthy controls. Type D Scale (DS14) and General Health Survey Short Form-36 (SF-36) were used in the collection of data.

RESULTS

Patients with anal fissure scored lower on physical roles and bodily pain dimensions of SF-36 than healthy subjects (p < 0.05). Thirty-three patients with anal fissure (33%) and 16 controls (16%) had scored above the cut-off score of the DS14 (p < 0.05). Patients with a type D personality were found to score lower on bodily pain and social roles domains of HRQL than patients without a type D personality.

CONCLUSIONS

Type D personality was associated with increased perceived bodily pain and social roles in patients with anal fissure. Type D personality construct may be an important consideration when assessing HRQL outcomes. A multidimensional approach may be valuable in the assessment of patients presenting with anal fissure, because a subgroup with type-D personality might benefit from psychological therapies.

Validation of the chronic liver disease questionnaire in Serbian patients

AIM: To translate into Serbian and to investigate the validity of the cross-culturally adapted the chronic liver disease questionnaire (CLDQ).

METHODS: The questionnaire was validated in 103 consecutive CLD patients treated between October 2009 and October 2010 at the Clinic for Gastroenterology, Clinical Centre of Serbia, Belgrade (Serbia). Exclusion criteria were: age < 18 years, psychiatric disorders, acute complications of CLD (acute liver failure, variceal bleeding, and spontaneous bacterial peritonitis), hepatic encephalopathy (grade > 2) ​​and liver transplantation. Evaluation of the CLDQ was done based on the following parameters: (1) acceptance is shown by the proportion of missing items; (2) internal reliabilities were assessed for multiple item scales by using Cronbach alpha coefficient; and (3) in order to assess whether the allocation of items in the domain corresponds to their distribution in the original questionnaire (construction validity), an exploratory factor analysis was conducted. Discriminatory validity was determined by comparing the corresponding CLDQ score/sub-score in patients with different severity of the diseases.

RESULTS: The Serbian version of CLDQ questionnaire completed 98% patients. Proportion of missing items was 0.06%. The total time needed to fill the questionnaire was ranged from 8 to 15 min. Assistance in completing the questionnaire required 4.8% patients, while 2.9% needed help in reading, and 1.9% involved writing assistance. The mean age of the selected patients was 53.8 ± 12.9 years and 54.4% were men. Average CLDQ score was 4.62 ± 1.11. Cronbach’s alpha for the whole scale was 0.93. Reliability for all domains was above 0.70, except for the domain “Activity” (0.49). The exploratory factor analysis model revealed 6 factors with eigenvalue of greater than 1, explaining 69.7% of cumulative variance. The majority of the items (66%) in the Serbian version of the CLDQ presented the highest loading weight in the domain assigned by the CLDQ developers: “Fatigue” (5/5), “Emotional function” (6/8), “Worry” (5/5), “Abdominal symptoms” (0/3), “Activity” (0/3), “Systemic symptoms” (3/5). The scales “Fatigue” and “Worry” fully corresponded to the original. The factor analysis also revealed that the factors “Activity” and “Abdominal symptoms” could not be replicated, and two new domains “Sleep” and “Nutrition” were established. Analysis of the CLDQ score/sub-score distribution according to disease severity demonstrated that patients without cirrhosis had lower total CLDQ score (4.86 ± 1.05) than those with cirrhosis Child’s C (4.31 ± 0.97). Statistically significant difference was detected for the domains “Abdominal symptoms” [F (3) = 5.818, P = 0.001] and “Fatigue” [F (3) = 3.39, P = 0.021]. Post hoc analysis revealed that patients with liver cirrhosis Child’s C had significantly lower sub-score “Abdominal symptoms” than patients without cirrhosis or liver cirrhosis Child’s A or B. For domain “Fatigue”, patients with cirrhosis Child’s C had significantly lower score, than non-cirrhotic patients.

CONCLUSION: The Serbian version of CLDQ is well accepted and represents a valid and reliable instrument in Serbian sample of CLD patients.

[Practical aspects for minimizing errors in the cross-cultural adaptation and validation of quality of life questionnaires]

BACKGROUND

The development and validation of questionnaires for evaluating quality of life (QoL) has become an important area of research. However, there is a proliferation of non-validated measuring instruments in the health setting that do not contribute to advances in scientific knowledge.

AIMS

To present, through the analysis of available validated questionnaires, a checklist of the practical aspects of how to carry out the cross-cultural adaptation of QoL questionnaires (generic, or disease-specific) so that no step is overlooked in the evaluation process, and thus help prevent the elaboration of insufficient or incomplete validations.

METHODS

We have consulted basic textbooks and Pubmed databases using the following keywords quality of life, questionnaires, and gastroenterology, confined to «validation studies» in English, Spanish, and Portuguese, and with no time limit, for the purpose of analyzing the translation and validation of the questionnaires available through the Mapi Institute and PROQOLID websites.

RESULTS

A checklist is presented to aid in the planning and carrying out of the cross-cultural adaptation of QoL questionnaires, in conjunction with a glossary of key terms in the area of knowledge. The acronym DSTAC was used, which refers to each of the 5 stages involved in the recommended procedure. In addition, we provide a table of the QoL instruments that have been validated into Spanish.

CONCLUSIONS

This article provides information on how to adapt QoL questionnaires from a cross-cultural perspective, as well as to minimize common errors.

Health-related quality of life and survival in Chinese patients with chronic liver disease

Background

To investigate the relationship between health-related quality of life (HRQOL) and survival in Chinese patients with chronic liver disease (CLD).

Methods

HRQOL was measured with the Chinese version of Short Form 36 (SF-36). SF-36 scores, demographic and clinical data were collected at baseline and after 18 months follow-up. Kaplan-Meier and Cox Proportional Hazard Regression survival analyses were used for interpretation of data. Surviving patients were censored in the analyses.

Results

A total of 415 Chinese patients with CLD and 86 healthy controls were enrolled. During the follow-up period 50 patients died. SF-36 scores in healthy controls and surviving patients were higher compared with those in deceased patients. Scores of physical component summary (PCS) in healthy controls, surviving and deceased patients were 54.1 ± 5.2, 48.9 ± 7.7 and 33.5 ± 8.2 respectively (p < 0.001). Scores of mental component summary (MCS) in healthy controls, surviving and deceased patients were 56.6 ± 8.2, 53.0 ± 5.6 and 37.1 ± 12.1 (p < 0.001) respectively. Survival was significantly associated with PCS and MCS scores, and the presence of ascites.

Conclusions

HRQOL was associated with survival in patients with CLD. PCS and MCS scores were predictors of survival.

Health-related quality of life in chinese patients with chronic liver disease

Aim. To investigate the factors contributing to health-related quality of life (HRQOL) in Chinese patients with chronic liver disease (CLD). Methods. HRQOL was measured with SF-36v2 Chinese version. Demographic and clinical data were collected, and patients with liver cirrhosis were divided into Child's Class A, B, and C according to Child-Turcotte-Pugh scoring system. Results. A total of 392 Chinese patients with CLD and 91 healthy controls were enrolled. HRQOL in patients with CLD was lower than that in healthy controls. Score of PCS in healthy controls was 54.6 ± 5.5 and in CLD was 47.8 ± 8.8 (P = 0.000). Score of MCS in healthy controls was 56.4 ± 8.1 and in CLD was 51.7 ± 7.4 (P = 0.000). Increasing severity of CLD from no cirrhosis to advanced cirrhosis was associated with a decrease on all domains of the SF-36 (P < 0.05). Stepwise linear regression analysis showed that severity of disease, age, present ascites, present varices, and prothrombin time had significant effect on physical health area. Severity of disease, female, present varices, total bilirubin, prothrombin time, and hemoglobin had significant effect on mental health area. Conclusions. Patients with CLD had impaired HRQOL. Increasing severity of CLD was associated with a decrease on HRQOL. Old age, female gender, advanced stage of CLD, present ascites, hyperbilirubinemia, and prolonging prothrombin time were important factors reducing HRQOL.

Translation and validation of the Greek chronic liver disease questionnaire

AIM: To translate into Greek and validate the chronic liver disease questionnaire (CLDQ).

METHODS: Two hundred and six consecutive adult patients with the diagnosis of a chronic liver disease from 2 general hospitals in Athens were enrolled in the study from May to September 2008. In order to assess their quality of life (QOL) the CLDQ was applied. The instrument was translated from English, back translated and reviewed in focus groups within the framework of a large multicenter study. The measurements that were performed included: 2 independent sample t tests, one-way analysis of variance, reliability coefficients, explanatory factor analysis using a varimax rotation and the principal components method.

RESULTS: One hundred and twenty five (61%) patients were men, half were aged 40-59 years and > 33% were > 60 years old. Among the patients, 48 (23%) were hospitalized and 97 (47%) were cirrhotic according to the Child-Pugh score. The internal consistency of the Greek CLDQ version using Cronbach’s alpha coefficient was found to be 0.93. Exploratory factor analysis identified 7 domains accounting for 65% of the variance of CLDQ items and only partially overlapping with those found in the original version. The area under the receiver operating characteristics curve was calculated at 0.813 and the logistic estimate for the threshold score of 167.50 provided a sensitivity of 74.3% and a specificity of 71.6% for the model.

CONCLUSION: Our data confirmed the validity of the Greek version of the CLDQ in identifying the QOL among patients with chronic liver disease.

Quality of life assessment of patients with chronic liver disease in eastern India using a Bengali translation chronic liver disease questionnaire

AIMS

The aim of this study was to translate and validate chronic liver disease questionnaire (CLDQ) into Bengali using a standard protocol and use it to assess the impact of socioeconomic factors, etiology, disease severity and complications on the quality of life of patients.

METHODS

Formal translation of CLDQ to Bengali was done. Cronbach's alpha and test-retest was performed for reliability analysis. Patients with clinically stable chronic liver disease (CLD) without significant associated co-morbid states were administered Bengali CLDQ in the Liver Clinic. The clinical, biochemical and disease parameters were recorded for analysis.

RESULTS

Bengali CLDQ was administered to 100 patients with CLD. Cronbach's alpha of overall scores was 0.90 and test-retest correlation coefficient of average CLDQ was 0.86 (P<0.001). Patients with history of decompensation (96.51 vs. 109.61; P=0.039) and Child's C status (92.24 vs. 105.71; P=0.028) had significantly lower CLDQ scores. CLDQ scores showed a moderate inverse correlation with Child's status (r= -0.35) and a poor correlation with MELD score (r= -0.09).

CONCLUSION

Bengali translation of CLDQ was found to be reliable. History of decompensation, Child's C status was associated with worse CLDQ scores. Child's status may have some role in predicting quality of life of patients with CLD. MELD score had poor predictability of quality of life.

Adaptação cultural do Chronic Liver Disease Questionnaire (CLDQ) para população brasileira

Nesse estudo realizaram-se a tradução para o português e a adaptação cultural do instrumento Chronic Liver Disease Questionnaire (CLDQ) para uso no Brasil. O instrumento foi traduzido da versão original (inglês) para a língua portuguesa pelos autores e, posteriormente, revisado e avaliado quanto ao grau de dificuldade das traduções e equivalência por tradutores bilíngües. O instrumento foi, então, aplicado em 20 pacientes com hepatopatia crônica selecionados aleatoriamente. Não houve dificuldade na compreensão do instrumento, todas as questões foram consideradas aplicáveis pelos pacientes, e a equivalência cultural do CLDQ foi demonstrada sem que mudanças na tradução original precisassem ser feitas. A tradução e a adaptação cultural do CLDQ para o português, no Brasil, foram realizadas, tendo sido cumprida esta importante etapa para sua validação e utilização em nosso meio.

The GABA(B) receptor agonist AZD9343 inhibits transient lower oesophageal sphincter relaxations and acid reflux in healthy volunteers: a phase I study

BACKGROUND

Transient lower oesophageal sphincter relaxations (TLESRs) represent an interesting target for the treatment of gastro-oesophageal reflux. Baclofen reduces TLESRs and reflux episodes, but is not optimal for clinical application because of its central side effects. Therefore, new agents are required.

AIM

To study the effect of AZD9343, a new selective GABA(B) receptor agonist, in healthy volunteers.

METHODS

A total of 27 subjects participated in a placebo-controlled, randomized, two-centre phase I study. Subjects underwent oesophageal manometry and pH-metry for 3 h postprandially. Before meal ingestion, a single oral dose of placebo, 60 and 320 mg AZD9343 or 40 mg baclofen was given on four separate days.

RESULTS

Somnolence was reported after 320 mg AZD9343 and baclofen. Reversible short-lasting paraesthesia was reported after AZD9343. AZD9343 320 mg and baclofen significantly reduced the number of TLESRs with 32% and 40% respectively. Acid reflux was significantly decreased by AZD9343 and baclofen. Like baclofen, AZD9343 increased LES pressure before meal intake. AZD9343 320 mg and baclofen significantly reduced the swallowing rate.

CONCLUSIONS

Like baclofen, AZD9343 dose-dependently decreases the number of TLESRs and acid reflux episodes, increases LES pressure and reduces swallowing, extending the concept that GABA(B) agonists are potent reflux inhibitors. However, discovery of analogues with an improved side effect profile is warranted.

Functional status, health-related quality of life and symptom severity in patients with chronic intestinal pseudo-obstruction and enteric dysmotility

OBJECTIVE

To investigate whether patients with chronic intestinal pseudo-obstruction (CIP) differ from those with enteric dysmotility (ED) regarding self-reported measures of functional status, health-related quality of life (HRQoL) and gastrointestinal symptoms.

MATERIAL AND METHODS

The study comprised 28 patients with CIP (median age 48, range 28-80 years) and 26 with ED (median age 50, range 20-75 years). Three self-administered questionnaires were used: the Sickness Impact Profile (SIP), the Swedish HRQoL Questionnaire (SWED-QUAL) and the Gastrointestinal Symptom Rating Scale (GSRS).

RESULTS

Patients with CIP reported significantly greater functional impairment in the aggregated physical dimension of SIP (15.4 SD 19.7) than did patients with ED (5.0 SD 7.2, p<0.01). They also reported significantly poorer general health (SWED-QUAL) (28.0 SD 20.8) compared to those with ED (44.8 SD 25.2, p <0.01). Symptom severity correlated with several measures of HRQoL and functional status in patients with CIP but abdominal pain severity was the only independent predictor of HRQoL. Abdominal pain alone explained between 21% and 67% of the variance in SWED-QUAL subscales. Likewise, the severity of indigestion symptoms among patients with CIP explained 20-24% of the variance in the SIP subscales, emotional behaviour and work. Much less correlation between symptom severity and functional impairment or HRQoL was found in patients with ED. We found no difference in symptom severity (GSRS) between the two groups.

CONCLUSIONS

Patients with CIP reported a greater impairment of functional status and HRQoL than did patients with ED. Symptom severity had a stronger influence on functional status and HRQoL in patients with CIP.

Translation and validation of the Chinese version of the Gastrointestinal Quality of Life Index in patients with gastric tumor

OBJECTIVE

Patients with gastric tumor are known to have deterioration in quality of life (QOL) following surgery. However, there is no valid disease-specific self-report QOL measure for clinical practice and research designated for Chinese in Hong Kong. The current study aimed at translating and validating a Chinese version of the Gastrointestinal Quality of Life Index (C-GIQLI) for use in patients with gastric tumors after gastrectomy.

METHODS

A translation of the English version of the instrument was performed. The psychometric properties of the C-GIQLI were investigated using internal consistency analysis, correlational analysis, and confirmatory factor analysis in 140 Chinese patients who had undergone surgery for gastric tumor.

RESULTS

The C-GIQLI demonstrated good test-retest reliability, internal consistency, and a factor structure consistent with the measurement model of the European version of the instrument.

CONCLUSION

The C-GIQLI is recommended as a valid and reliable self-report measure of QOL in patients with gastric tumor after gastrectomy.

Short-term duodenal seal oil administration normalised n-6 to n-3 fatty acid ratio in rectal mucosa and ameliorated bodily pain in patients with inflammatory bowel disease

Background

A high dietary intake of n-6 compared to n-3 fatty acids (FAs) may promote the production of pro-inflammatory eicosanoids and cytokines. In two recent studies, short-term (10-day) duodenal administration of n-3 polyunsaturated fatty acid rich seal oil ameliorated joint pain in patients with inflammatory bowel disease (IBD). Using unpublished data from these two studies we here investigated whether normalisation of the n-6 to n-3 FA ratio in blood and tissues by seal oil administration was associated with improved health related quality of life (HRQOL) as assessed by the generic short-form 36 (SF-36) questionnaire.

Results

In the first pilot study, baseline n-6 to n-3 FA ratio in rectal mucosal biopsies from 10 patients with IBD (9 of those had joint pain) was significantly increased compared with that in 10 control patients without IBD or joint pain. Following seal oil administration, the n-6 to n-3 FA ratio of the IBD-patients was significantly lowered to the level seen in untreated controls. In the subsequent, randomized controlled study (n = 19), seal oil administration reduced the n-6 to n-3 FA ratio in blood similarly and also the SF-36 assessed bodily pain, while n-6 FA rich soy oil administration had no such effect.

Conclusion

In these two separate studies, short-term duodenal administration of seal oil normalised the n-6 to n-3 FA ratio in rectal mucosa and improved the bodily pain dimension of HRQOL of patients with IBD-related joint pain. The possibility of a causal relationship between n-6 to n-3 FA ratio in rectal mucosa and bodily pain in IBD-patients warrants further investigations.

Impact of chronic conditions on quality of life in patients with inflammatory bowel disease

BACKGROUND

Although studies suggest that inflammatory bowel disease (IBD) has a significant impact on an individual's health-related quality of life, the added weight of other health conditions and comorbidities has not been investigated. The purpose of this study was to expand on prior research by taking into account the impact of other chronic health conditions on the health-related quality of life of individuals with IBD, and to develop a model to help clinicians understand the relative impact of various predictors of their patients' physical and mental health-related quality of life.

METHODS

615 patients from the gastroenterology outpatient practice of a large, urban university hospital received a self-administered survey including questions about their health conditions, the severity of their bowel symptoms, and their health-related quality of life (measured using the SF-36 instrument).

RESULTS

314 completed surveys were returned, resulting in a response rate of 51.1%. Two regression analyses were conducted to identify the role of patient demographic variables and other chronic conditions on the 2 primary outcomes of interest: the SF-36 Physical Component and Mental Component Summary scores. Statistically significant predictors of physical quality of life included IBD disease severity, arthritis, heart disease, age, anemia, back/shoulder pain, and hypertension; statistically significant predictors of mental health-related quality of life were IBD disease severity, depression/anxiety, age, and headaches.

CONCLUSIONS

IBD disease severity is the most important predictor of both physical and mental health-related quality of life in patients with this condition despite the presence of other chronic conditions.

Reliability and validity of a new scale to assess postoperative dysfunction after resection of upper gastrointestinal carcinoma

PURPOSE

We evaluated the purpose reliability and validity of a preliminary scale, which we developed to assess postoperative dysfunction after surgery for gastric and esophageal carcinoma.

METHODS

After interviews with 12 patients, reviews of previous studies, and discussions with experts, we identified the physical symptoms that develop after resection of upper gastrointestinal (GIT) carcinoma, and devised a preliminary scale comprised of 34 items. A questionnaire survey based on this scale was then sent to 283 patients.

RESULTS

The questionnaire was returned by 223 patients (78.8%), and 219 responses (98.2%) were valid. Among the 219 respondents, 168 had gastric carcinoma and 51 had esophageal carcinoma. After the elimination of scale items regarded as irrelevant based on statistical considerations and the judgment of experts, factor analysis was done. Seven factors were valid, namely, limited activity due to decreased food consumption, reflux, gastric dumping, nausea and vomiting, deglutition difficulty, pain, and difficulty with passing stools, which were often poorly formed. Scale reliability was confirmed by a Cronbach alpha-coefficient of 0.924. The validity of the construction of this scale was confirmed using the known-group technique based on the operative procedures performed, and the results of factorial validity.

CONCLUSION

Our preliminary scale is sufficiently reliable and valid, and will prove to be clinically useful.

Validación psicométrica de la traducción al español de la escala de evaluación de síntomas gastrointestinales (GSRS) y del cuestionario de calidad de vida de reflujo y dispepsia (QOLRAD) en los pacientes con enfermedad por reflujo gastroesofágico

INTRODUCTION

Pyrosis symptoms and their impact on the quality of life related with health (QLRH) are frequently evaluated in clinical trials. When a questionnaire is translated into a language other than the original, it is necessary to have a linguistic validation, although this is not sufficient unless the psychometric characteristics have been verified. This study aims to document the psychometric characteristics of the translation to Spanish of the gastrointestinal symptoms rating scale (GSRS) and quality of life in reflux and dyspepsia (QOLRAD).

MATERIAL AND METHOD

One hundred fifty eight patients with pyrosis symptoms (age: 51.0; SD: 16.3 years; men: 42.4%) completed the translation to Spanish of the GSRS, the pyrosis version of the QOLRAD, the Short-Form-36 (SF-36) and the hospital of anxiety and depression (HAD) scale. Seventy six patients were given an appointment for a second visit after one week, to fill out the GSRS and QOLRAD again.

RESULTS

The reliability of the internal consistence of the GSRS was 0.59-0.83 and that of the QOLRAD: 0.87-0.95, and test-retest reliability of the GSRS was 0.44-0.63 and QOLRAD: 0.77-0.85. Score of the important domains of the GSRS "reflux", "abdominal pain" and "indigestion" and above all those of the QOLRAD correlated significantly. The domain "abdominal pain" of the GSRS had a strong correlation (negative) with the relevant domains of the SF-36. The QOLRAD domains significantly correlated with all the related domains of the SF-36.

CONCLUSIONS

The psychometric characteristics of the translation to Spanish of the GSRS and QOLRAD were good, with satisfactory reliability and validity. However, the test-retest reliability of the "reflux" domain of the GSRS was not optimum.

Quality of life measures for fecal incontinence and their use in children

BACKGROUND

Fecal incontinence is a common problem within society from childhood through to the elderly. Its clinical assessment has focussed on severity and frequency of soiling episodes but it is increasingly recognized to have an impact on physical, psychological and social well-being (quality of life [QOL]). This is likely to be particularly important in childhood. The aim of the present study was to critically evaluate the development and application of disease-specific QOL measures, focusing particularly on their use in children.

METHODS

Generally recognized disease-specific QOL measures for fecal incontinence were identified and their generation and validation were critically evaluated.

RESULTS

Six instruments were identified: Ditesheim and Templeton QOL Scoring System, Manchester Health Questionnaire, Hirschsprung's Disease/Anorectal Malformation Quality of Life Questionnaire (HAQL), Gastrointestinal Quality of Life Index (GIQLI), Fecal Incontinence TyPE Specification, and the Fecal Incontinence Quality of Life Scale (FIQL). Although the FIQL appeared to be the better tool for adults with fecal incontinence because it was brief and had the best validity and reliability, it needed further modification to become appropriate for use in children. In particular, items relating to sexual activity were inappropriate.

CONCLUSION

Neither the FIQL nor other disease-specific instruments met basic psychometric standards for use in children with fecal incontinence. Substantial revision of currently available instruments will be required to meet the needs of this population.

Effects of a self-care program on quality of life of cirrhotic patients referring to Tehran Hepatitis Center

BACKGROUND

Chronic liver disease especially liver cirrhosis is one of the medical problems that substantially reduces the quality of life of its victims. Because of the chronic and irreversible nature of the disease, it needs self-care programs to be developed according to client's needs and to maintain their independence and sense of well-being. The purpose of this study was to determine the effects of a self-care educational program on Quality of Life (QoL) of a sample of Iranian cirrhotic patients.

METHODS

A quasi-experimental study was conducted on 44 cirrhotic patients in Tehran Hepatitis Center. Longitudinal case registry and random allocation technique were used to divide the sample into experimental (n = 21) and control (n = 23) groups. Chronic liver disease questionnaire (CLDQ) was used for measuring the quality of life. The experimental group was given a questionnaire to assess their educational needs. A self-care educational program was conducted and the patients were followed for 3 months. Then the quality of life of both groups was compared using descriptive and analytical statistics.

RESULTS

The experimental and control groups were the same concerning the effective factors on the quality of life, such as age, sex, etc (P > 0.05). There was no significant difference between QOL mean score of both groups before the intervention, however the QoL significantly improved in the experimental group after the intervention (P = 0.001), while the QoL decreased in control group.

CONCLUSION

The result of the present study confirmed the positive effects of the educational and self care programs on the QoL of cirrhotic patients. Extensive educational and self-care programs along with long-term follow up such as the program conducted in this study are suggested.

Patient reported outcomes in gastroesophageal reflux disease: an overview of available measures

Gastroesophageal reflux disease (GERD) is a common, chronic disorder. The main symptom of GERD is heartburn, although a diverse range of symptoms can be associated with the disease including acid regurgitation and epigastric pain. GERD is also a risk factor for Barrett's oesophagus and esophageal adenocarcinoma. The impact of GERD symptoms on patients' lives can be profound and is unrelated to the presence or absence of esophagitis. The impact of GERD can be measured by assessing the patient perspective using Patient Reported Outcomes (PROs). There are two categories of questionnaires that can be used to measure the effect of GERD on health-related quality of life (HRQoL), namely generic and disease or treatment specific. The use of PRO instruments has become more accepted in the assessment of disease treatment. Well-designed instruments that assess physical, psychological and emotional factors can provide clinicians with the data that will promote effective management decisions for the treatment of GERD. The most frequently used instruments in GERD are reviewed here, in terms of their psychometric properties.

Impact of psychosocial parameters on quality of life in patients with irritable bowel syndrome

AIM: To investigate the impact of psychosocial parameters on the quality of life (QOL) in healthcare seeking patients with irritable bowel syndrome (IBS).

METHODS: QOL and psychosocial parameters in consecutive 41 patients with IBS irritable bowel syndrome (IBS) according to Rome II criteria were measured by questionnaires including IBS-QOL, Pittsburgh sleep quality index (PSQI) and symptom checklist-90 (SCL-90), coping style, social supports, respectively. In the meantime, 37 normal subjects were served as a control group. The relationship between IBS-QOL and psychosocial parameters was investigated by regression analysis.

RESULTS: Compared with normal subjects, all subscales scores of QOL were lower (P < 0.05, respectively), especially in dysphoria, interference with activity, health worry, social reaction, and overall score (P = 0.000, respectively). In addition, IBS patients had more psychiatric symptoms (40.24±4.5, t = 2.63, P = 0.047), and higher scores of depression (0.64±0.24, t = 2.53, P = 0.020) and anxiety (0.67±0.30, t = 2.16, P = 0.016). The score of negative coping (40.79±8.01, P < 0.05), fancying (4.95±2.1, P = 0.001) and withdrawal (4.81±2.1, P = 0.004), as well as subjective supporting (23.92±4.2, P = 0.046) in IBS was higher than that in normal subjects. Among IBS patients, the quality of sleep and daily functions significantly decreased, PSQI and sleep disturbances as well as soporific using was markedly increased. Multiple regression analysis showed poorer quality of life in IBS was related with sleep quality (β = 0.281), negative life event (β = -0.363)and anxiety (β = -0.175).

CONCLUSION: QOL in healthcare seeking patients with IBS is impaired significantly, which is negatively associated with the abnormalities of many of psychosocial parameters.

Chronic liver disease questionnaire: Translation and validation in Thais

AIM: Quality of life (QOL) is a concept that incorporates many aspects of life beyond “health”. The chronic liver disease questionnaire (CLDQ) was developed to evaluate the impact of chronic liver diseases (CLD) on QOL. The objectives of this study were to translate and validate a liver specific questionnaire, the CLDQ.

METHODS: The CLDQ was formally translated from the original version to Thai language with permission. The translation process included forward translation, back translation, cross-cultural adaptation and a pretest. Reliability and validity of the translated version was examined in CLD patients. Enrolled subjects included CLD and normal subjects with age- and sex-matched. Collected data were demography, physical findings and biochemical tests. All subjects were asked to complete the translated versions of CLDQ and SF-36, which was previously validated. Cronbach’s alpha and test-retest were performed for reliability analysis. One-way Anova or non-parametric method was used to determine discriminant validity. Spearman’s rank correlation was used to assess convergent validity. P-value < 0.05 was considered statistically significant.

RESULTS: A total of 200 subjects were recruited into the study, with 150 CLD and 50 normal subjects. Mean ages (SD) were 47.3 (11.7) and 49.1 (8.5) years, respectively. The number of chronic hepatitis: cirrhosis was 76:74, and the ratio of cirrhotic patients classified as Child A:B:C was 37 (50%): 26 (35%): 11 (15%). Cronbach’s alpha of the overall CLDQ scores was 0.96 and of all domains were higher than 0.93. Item-total correlation was > 0.45. Test-retest reliability done at 1 to 4 wk apart was 0.88 for the average CLDQ score and from 0.68 to 0.90 for domain scores. The CLDQ was found to have discriminant validity. The highest scores of CLDQ domains were in the normal group, scores were lower in the compensated group and lowest in the decompensated group. The significant correlation between domains of the CLDQ and SF-36 was found. The average CLDQ score was strongly correlated with the general health domain of SF-36. (P = 0.69: P = 0.01).

CONCLUSION: The translated CLDQ is valid and applicable in Thais with CLD. CLDQ reveals that QOL in these patients is lower than that in normal population. QOL is more impaired in advanced stage of CLD.

Intestinal microecology and quality of life in irritable bowel syndrome patients

AIM: It has been noticed that gastroenteritis or dysentery plays a role in pathogenesis of irritable bowel syndrome (IBS), and antibiotics can increase functional abdominal symptoms, both of which may be partly due to intestinal flora disorders. This study was to determine the change of gut flora of IBS, a cluster of abdominal symptoms. Because of the chronic course and frequent occurrence of the disease, IBS patients suffered much from it. So the quality of life (Qol) of IBS patients was also evaluated in this study.

METHODS: Twenty-five Rome II criteria-positive IBS patients were recruited, and 25 age and gender-matched healthy volunteers were accepted as control. The fecal flora, including Lactobacillus, Bifidobacterium, Bacteroides , C. perfringens Enterobacteriacea and Enterococus, were analyzed quantitatively and qualitatively. We also calculated the ratio of Bifidobacterium to Enterobacteriaceae (B/E ratio) in both IBS patients and controls. In both groups, the data were further analyzed based on age difference, and comparisons were made between the younger and elder subgroups. We also evaluated the quality of life (QoL) of IBS patients and the control group using the Chinese version of SF-36 health questionnaire.

RESULTS: In IBS patients, the number of fecal Bifidobacterium was significantly decreased and that of Enterobacteriaceae was significantly increased compared with that in healthy controls (both P < 0.05).The mean microbial colonization resistance (CR) of the bowel in IBS patients was smaller than 1, making a significant difference compared with that in control which was more than 1 (P < 0.01). There was no significant difference in gut flora between two subgroups. While in control, the elder subgroup presented more Enterobacteriacea than the younger one (P < 0.05). Compared with the control group, IBS patients had significantly lower scores on all SF-36 scales, with the exception of physical functioning. However, there was no significant correlation between quality of life and enteric symptoms in IBS patients.

CONCLUSION: There are intestinal flora disorders in IBS patients, which may be involved in triggering the IBS-like symptoms. IBS patients experience significant impairment in QoL, however, the impairment is not caused directly by enteric symptoms.

Psychometric validation of the German translation of the Gastrointestinal Symptom Rating Scale (GSRS) and Quality of Life in Reflux and Dyspepsia (QOLRAD) questionnaire in patients with reflux disease

BACKGROUND

Symptoms of heartburn has an impact on health-related quality of life (HRQL). When a questionnaire is translated into a new language, a linguistic validation is necessary but not sufficient unless the psychometric characteristics have been verified. The aim is to document the psychometric characteristics of the German translation of the Gastrointestinal Symptom Rating Scale (GSRS) and Quality of Life in Reflux and Dyspepsia (QOLRAD) questionnaire.

METHODS

142 patients with symptoms of heartburn (Age: M = 47.5, +/- 14.6; Males = 44.4%) completed the German translation of GSRS, the QOLRAD, the Short-Form-36 (SF-36) and the Hospital Anxiety and Depression (HAD) scale.

RESULTS

The internal consistency reliability of GSRS ranged from 0.53-0.91 and of QOLRAD from 0.90-0.94, respectively. The test-retest reliability of GSRS ranged from 0.49-0.73 and of QOLRAD from 0.70-0.84. The relevant domains of the GSRS and QOLRAD domain scores significantly correlated. GSRS domains of Abdominal Pain and Constipation correlated (negatively) with most of the domains of the SF-36. The relevant QOLRAD domains significantly correlated with all SF-36 domains.

CONCLUSIONS

The psychometric characteristics of the German translation of GSRS and QOLRAD were found to be good, with satisfactory reliability and validity. The reliability of the GSRS Abdominal Pain domain was moderate.

Diverticular disease has an impact on quality of life -- results of a preliminary study

OBJECTIVE

Diverticular disease (DD) is common in the western world, and carries a significant morbidity. Although patients can have long standing symptoms no research on quality of life (QoL) in DD exists in the literature. Assessment of QoL may be useful in decision making and selection of patients who would be appropriate candidates for elective surgical treatment. The aim of this study was to examine whether DD has an impact on QoL.

MATERIALS AND METHODS

A combination of structured interview and questionnaire survey was performed. One hundred people were divided into two groups: Group A, 50 patients with symptomatic DD as their primary diagnosis; Group B, A control group of 50 healthy volunteers. A structured QoL questionnaire, examining bowel symptoms, systemic symptoms, emotional symptoms and social function, was completed by the subjects in both the patient and the control group.

RESULTS

In the patient group scores fell well below the optimum QoL scores in each of the subscales particularly in the areas of bowel symptoms (43.8 vs 65.4 for controls) and emotional function (55.1 vs 75.9 for controls). Patients with DD had statistically significantly lower QoL scores than controls and this difference was consistent in all four examined areas (P < 0.003 for all categories).

CONCLUSION

Our preliminary study suggests that DD does affect a person's QoL. The authors recommend that further research is required in the development of a (QoL) scoring system specific for patients with diverticular disease. Having developed a tool that can accurately measure the subjective health status (QoL) of this disease group we will then be able to develop a more systematic approach to the delivery of treatment, management and care of patients with diverticular disease.