ABSTRACT
BACKGROUND & AIMS: Health-related quality of life (HRQoL) is impaired in patients with Inflammatory Bowel Disease (IBD). The aim was prospectively to assess and validate the pattern of HRQoL in an unselected, population-based inception cohort of IBD patients from Eastern and Western Europe. METHODS: The EpiCom inception cohort consists of 1560 IBD patients from 31 European centres covering a background population of approximately 10.1 million. Patients answered the disease specific Short Inflammatory Bowel Disease Questionnaire (SIBDQ) and generic Short Form 12 (SF-12) questionnaire at diagnosis and after one year of follow-up. RESULTS: In total, 1079 patients were included in this study. Crohn's disease (CD) patients mean SIBDQ scores improved from 45.3 to 55.3 in Eastern Europe and from 44.9 to 53.6 in Western Europe. SIBDQ scores for ulcerative colitis (UC) patients improved from 44.9 to 57.4 and from 48.8 to 55.7, respectively. UC patients needing surgery or biologicals had lower SIBDQ scores before and after compared to the rest, while biological therapy improved SIBDQ scores in CD. CD and UC patients in both regions improved all SF-12 scores. Only Eastern European UC patients achieved SF-12 summary scores equal to or above the normal population. CONCLUSION: Medical and surgical treatment improved HRQoL during the first year of disease. The majority of IBD patients in both Eastern and Western Europe reported a positive perception of disease-specific but not generic HRQoL. Biological therapy improved HRQoL in CD patients, while UC patients in need of surgery or biological therapy experienced lower perceptions of HRQoL than the rest.
Subject(s)
Digestive System Surgical Procedures/methods , Disease Management , Inflammatory Bowel Diseases/therapy , Population Surveillance , Quality of Life , Adolescent , Adult , Aged , Aged, 80 and over , Europe/epidemiology , Female , Follow-Up Studies , Humans , Inflammatory Bowel Diseases/epidemiology , Inflammatory Bowel Diseases/psychology , Male , Middle Aged , Morbidity/trends , Prognosis , Prospective Studies , Surveys and Questionnaires , Young AdultABSTRACT
BACKGROUND AND AIMS: The EpiCom study and inception cohort was initiated in 2010 in 31 centers from 14 Western and 8 Eastern European countries, covering a 10.1million person background population. Our aim was to investigate whether there is a difference between Eastern and Western Europe in health care and education of patients with inflammatory bowel disease (IBD). METHODS: A quality of care (QoC) questionnaire was developed in the EpiCom group consisting of 16 questions covering 5 items: time interval between the onset of symptoms and diagnosis, information, education, empathy and access to health care providers. RESULTS: Of 1,515 patients, 947 (217 east/730 west) answered the QoC questionnaire. Only 23% of all patients had knowledge about IBD before diagnosis. In Eastern Europe, significantly more patients searched out information about IBD themselves (77% vs. 68%, p<0.05), the main source was the Internet (92% vs. 88% p=0.23). In Western Europe, significantly more patients were educated by nurses (19% vs. 1%, p<0.05), while in Eastern Europe, gastroenterologists were easier to contact (80% vs. 68%, p<0.05). CONCLUSION: Health care differed significantly between Eastern and Western Europe in all items, but satisfaction rates were high in both geographic regions. Because of the low awareness and the rising incidence of IBD, general information should be the focus of patient organizations and medical societies. In Western Europe IBD nurses play a very important role in reducing the burden of patient management.
Subject(s)
Inflammatory Bowel Diseases/therapy , Patient Education as Topic , Quality of Health Care/statistics & numerical data , Adolescent , Adult , Aged , Aged, 80 and over , Cohort Studies , Europe/epidemiology , Europe, Eastern/epidemiology , Female , Humans , Inflammatory Bowel Diseases/diagnosis , Inflammatory Bowel Diseases/psychology , Male , Middle Aged , Patient Education as Topic/statistics & numerical data , Patient Satisfaction/statistics & numerical data , Surveys and Questionnaires , Time Factors , Young AdultSubject(s)
Graft Survival , Immunosuppression Therapy/methods , Intestine, Small/transplantation , Transplantation, Homologous/immunology , Animals , Cyclosporine/therapeutic use , Immunosuppressive Agents/therapeutic use , Intestine, Small/physiology , Male , Nutritional Status , Rats , Rats, Inbred BN , Rats, Inbred Lew , Tacrolimus/therapeutic use , Time Factors , Transplantation, Homologous/physiologyABSTRACT
The case of a patient is reported, who developed peliosis hepatis during contraceptive steroid therapy. This was clinically manifested as a spontaneous hepatic hematoma. No underlying liver tumor could be detected by both invasive and non-invasive investigations. Oral contraceptives should be listed among the potential albeit exceptional cases of liver hematoma, and this clinical presentation of peliosis hepatis added to the possible manifestations of that obscure condition.
