Sustained improvement of health-related quality of life in Crohn's disease patients treated with infliximab and azathioprine for 4 years.

BACKGROUND: Infliximab induces remission and improves the health-related quality of life (HRQOL) of patients with refractory or fistulous Crohn's disease (CD). However, little information is available as to whether its effect on HRQOL is sustained over time. The objective was to measure the HRQOL of CD patients in long-term clinical remission. METHODS: Prospective, observational study was undertaken in patients with CD in infliximab-induced clinical remission (Harvey index <3) for at least 6 months, and receiving long-term infliximab and azathioprine maintenance therapy. Patients were followed for 4 years or until clinical relapse (Harvey index >3). HRQOL was assessed annually using the validated Spanish version of the disease-specific 36-item Inflammatory Bowel Disease Questionnaire (IBDQ-36) and the EuroQol-5D. RESULTS: Forty-nine patients with CD in stable clinical remission were included at baseline. At 12 months, n = 42 patients remained in remission, at 24 months n = 32 patients, at 36 months n = 13, and in the last visit at 48 months 6 patients remained in clinical remission. The overall score on the IBDQ-36 remained unchanged in patients with stable, inactive CD (median overall score of 6.1 at baseline and 6.5 at 4 years). Scores on all 5 dimensions of the IBDQ-36 remained unchanged over the study period in stable patients. Patients in remission scored highly on the preference value ratings of the EuroQol-5D (scores of 1.0) and remained unchanged in patients who remained in remission. CONCLUSIONS: Sustained clinical remission of CD achieved with maintenance treatment maintains HRQOL over long-term follow-up.

Quality of life in cirrhotic patients and liver transplant recipients / Calidad de vida en pacientes cirróticos y trasplantados hepáticos

This study analyses the health related quality of life in patients diagnosed with hepatic cirrhosis (HC) in the three Child-Pugh stages (A, B and C) and in liver transplant recipients (OLT). Health related quality of life was quantified by the multidimensional psychometric test PLC (Siegrits, Boer and Junge, 1996). In general, patients HC and OLT had a poorer score than the control group in Physical Wellbeing, Physical Function, Positive Mood, Negative Mood and Psychological Wellbeing scales. Also, patients with OLT present a better quality of life than patients with advanced cirrhosis (Child B and C) in scales that evaluate Physical, Psychological and Social functions. The OLT group even obtained higher scores in the Positive Mood scale than Child-A cirrhotics. Our results suggest that although quality of life in OLT patients does not reach levels of healthy individuals, it is significantly better than in cirrhotic patients, especially than those in advanced stages

Este estudio analiza la calidad de vida relacionada con la salud en pacientes diagnosticados de cirrosis hepática (CH) en los tres estadios Child-Pugh (A, B y C) y en pacientes trasplantados (OLT). La calidad de vida ha sido cuantificada por la prueba psicométrica multidimensional PLC (Siegrits, Boer and Junge, 1996). En general, los pacientes CH y OLT presentaron peores puntuaciones que el grupo control en las dimensiones de Capacidad física, Función física, Ánimo positivo, Ánimo negativo y Bienestar psicológico. Aunque los pacientes OLT mostraron mejor calidad de vida que los pacientes con estados avanzados de cirrosis (Child B y C) en las escalas que evalúan las funciones física, psicológica y social. El grupo OLT presentan puntuaciones más altas en la dimensión Ánimo positivo respecto al grupo de pacientes cirróticos en estadio Child A. Nuestros resultados sugieren que la calidad de vida en pacientes OLT no alcanza los niveles de la población sana, pero es significativamente mejor que en pacientes CH especialmente en fases avanzadas

Cognitive deficits in patients with hepatic cirrhosis and in liver transplant recipients.

This study assessed cognitive deficit in patients diagnosed with different stages of hepatic cirrhosis and in liver transplant recipients. A short protocol consisting of several psychometric tests was used. Cirrhotic patients showed a degree of mental impairment in all the functions studied. The severity of the deficit was related to the degree of hepatic dysfunction. In contrast, liver transplant recipients presented only a slightly altered cerebral dysfunction in comparison to the control group. Their cognitive capacity was slightly better than that of patients with asymptomatic cirrhosis.