Association between colonic polyps and diverticular disease

AIM： To evaluate the association between colonic polyps and diverticular disease in Japan. METHODS： We retrospectively reviewed the medical records of 672 consecutive patients who underwent total colonoscopy between August 2006 and April 2007 at Nishinjo Hospital, Okinawa, Japan. Patients with a history of any of the following were excluded from the study： previous polypectomy, colonic resection, and inflammatory bowel diseases. The association between colonic polyps and diverticular disease was analyzed by logistic regression analysis, adjusted for age and sex. RESULTS： Prevalence of colonic polyps in all patients with diverticular disease was significantly higher than that in those without diverticular disease （adjusted odds ratio 1.7）. CONCLUSION： Our data showed that patients with diverticular disease have a higher risk of colonic polyps compared to those without.     

大骨节病健康相关生存质量架构的质性研究

目的 建立我国大骨节病健康相关生存质量的架构,以期反映出大骨节病对患者生存质量的影响.方法 运用质性描述性研究,采用世界卫生组织(WHO)对健康及生存质量的定义发展半开放式问题,通过焦点团体访谈和面对面访谈,收集陕西省大骨节病患病率较高的病区麟游县、永寿县29名大骨节病专家和48名大骨节病患者的意见,并用WHO生存质量问卷(WHOQOL-100)的架构作为模板,用内容模板法分析访谈资料.结果 大骨节病健康相关生存质量架构包含了4个领域:身体活动能力、家庭/社会支持、经济、心理状态;反映在11个方面:疼痛与不适,身体功能与活动限制、饮食与睡眠、社会关系、对家庭责任的担忧、社会支持、经济状况、住房及周围环境、对外貌的担心、精神状况、总的健康状况;共有69个条目.结论 建立了大骨节病健康相关生存质量的架构,该架构凸显了大骨节病对患者生存质量的影响,特异性较强.     

Health related quality of life survey about children and adolescents with juvenile idiopathic arthritis

This study aimed to investigate the proxy-reported Health related quality of life (HRQOL) and its determinants in patients with juvenile idiopathic arthritis (JIA). It was hypothesized that HRQOL would decrease with worsening disease and disability. Data were available in cross-sectional study on children and adolescents with JIA according to the ILAR criteria. Patient demographics, type of JIA, clinical determinants and laboratory parameters relating to JIA were obtained for each patient. Functional disability was assessed using the parent’s or children’s version of the child health assessment questionnaire (CHAQ). The HRQOL was evaluated using the juvenile arthritis quality of life questionnaire (JAQQ). These questionnaires were previously translated and validated in Moroccan children. A total of 80 participants were enrolled with mean age of 11 [6–17 years], and female predominance (59%). Many patients (42.5%) had oligoarticular subtype; 31.3% polyarticular subtypes and 26.2% systemic form. The mean global score of JAQQ was 2.6 ± 1.3 (1–6). Patients with persistant oligoarticular had better gross motor function (P < 0.0001), better fine motor function (P < 0.0001), less psychosocial impact (P = 0.001), and less symptoms (P = 0.001) in comparison with polyarticular and systemic subtypes. The HRQOL assessed by the JAQQ was worse in adolescent patients in comparison with children except for symptoms (P = 0.15). The gender (P = 0.95), age at onset of JIA (P = 0.81), and evolution duration (P = 0.34) were not correlated with global score of JAQQ. The diagnosis delay was significantly associated with decrease of HRQOL (P = 0.001). The decrease of HRQOL was correlated with disease activity [pain (VAS), painful and swollen joints, erythrocyte sedimentation rate (for P < 0.0001)], with disability index (CHAQ) (P = 0.001) and presence of hip involvement (P = 0.01). This study suggests that JIA can have a significant adverse effect on the HRQOL of moroccan patients, particularly adolescents with polyarticular and systemic subtypes. Disease duration, disability score (CHAQ) and pain were the strongest determinants of poorer HRQOL.     

慢性阻塞性肺疾病患者3年健康相关生活质量的变化及危险因素的分析

目的 探讨生活中COPD患者3年健康相关生活质量(health-related quality of life,HRQoL)的变化规律及影响生活质量变化的可能危险因素.方法 基于慢性呼吸病管理中心数据库3年的COPD患者临床资料,采用回顾性研究,利用圣乔治呼吸问卷(Saint George's Respiratory Questionnaire,SGRQ)评估HRQoL,分析SGRQ随时间变化规律;根据SGRQ 3年变化值进行分组,利用Logistic回归探寻影响HRQoL变化的危险因素.结果 60例COPD患者中63.3％～83.3％的患者经吸入激素联合长效支气管舒剂治疗后,SGRQ总分及各部分评分与基线值比较无明显上升(t值分别为:0.147、-0.014、0.335、0.227,P值均＞0.05),FEV1、FEV1％pred、6分钟步行距离较基线值下降(t值分别为:3.943、6.974、3.977,P值均＜0.05),BODE指数较基线值上升(t=-9.916,P＜0.05);其中生活质量相对稳定者36例(60％),多因素Logistic回归提示BODE指数升高是HRQoL下降的独立危险因素(OR =1.686,P=0.017),重度急性加重次数对其下降亦有影响(OR=3.316,P=0.052).结论 生活中大部分COPD患者经吸入激素联合长效支气管舒张剂治疗后生活质量相对稳定,除药物影响外,BODE指数升高是生活质量下降的独立危险因素,重度急性加重次数可能也对健康相关生活质量的变化具有预测价值.     

Increase in colonic diverticular hemorrhage and confounding factors

AIM: To classify changes over time in causes of lower gastrointestinal bleeding(LGIB) and to identify factors associated with changes in the incidence and characteristics of diverticular hemorrhage(DH).METHODS: A total of 1803 patients underwent colonoscopy for overt LGIB at our hospital from 1995 to 2013. Patients were divided into an early group(EG, 1995-2006, n = 828) and a late group(LG, 2007-2013, n = 975), and specific diseases were compared between groups. In addition, antithrombotic drug(ATD) use and nonsteroidal anti-inflammatory drug(NSAID) use were comparedbetween patients with and without DH. RESULTS: Older patients(≥ 70 years old) and those with colonic DH were more frequent in LG than in EG(P 0.01). Patients using ATDs as well as NSAIDs, male sex, obesity(body mass index ≥ 25 kg/m2), smoking, alcohol drinking, and arteriosclerotic diseases were more frequent in patients with DH than in those without. CONCLUSION: Incidence of colonic DH seems to increase with aging of the population, and factors involved include use of ATDs and NSAIDs, male sex, obesity, smoking, alcohol drinking, and arteriosclerotic disease. These factors are of value in handling DH patients.     

Health related quality of life after conservative or invasive treatment of inducible postinfarction ischaemia. DANAMI study group

OBJECTIVE—To assess health related quality of life in patients with inducible postinfarction ischaemia.
DESIGN—A questionnaire based follow up study on patients randomised to conservative or invasive treatment because of postinfarction ischaemia.
SETTING—Seven county hospitals in eastern Denmark and the Heart Centre, National University Hospital, Copenhagen, Denmark.
PATIENTS—113 patients with inducible postinfarction ischaemia: 51 were randomised to conservative treatment and 62 to invasive treatment. Average follow up time was three years (19-57 months).
MAIN OUTCOME MEASURES—SF-36, Rose angina and dyspnoea questionnaire, drug use, lifestyle, and cognitive function.
RESULTS—Invasively treated patients scored better on the SF-36 scales of physical functioning (p = 0.03) and on role-physical (p = 0.04) and physical component scales (p = 0.05) and took significantly less anti-ischaemic drug treatment. Angina occurred in 18% of the invasively treated patients and 31% of the conservatively treated patients (p = 0.09). However, more invasively treated patients suffered from concentration difficulties (18% v 4%; p = 0.04).
CONCLUSIONS—Patients who were treated invasively had better health related quality of life scores in the physical variables compared with conservatively treated patients. However, a larger proportion of invasively treated patients had concentration difficulties.


Keywords: SF-36; health related quality of life; postinfarction ischaemia     

Quality of life after surgery of the alimentary tract

In recent decades, patient-reported outcomes have become important in clinical medicine. Nowadays, health-related quality of life (HRQOL) is considered a primary outcome in many clinical trials, and it is often the major criterion for judging treatment success. At the beginning of the 21st century, morbidity and mortality rates after surgery of the alimentary tract have dropped dramatically and they can no longer be considered the only outcome measures to determine the success of a surgical procedure. QOL c...     

Health related quality of life (HRQoL) in ankylosing spondylitis patients: Relation to clinical features,disease activity and radiographic damage

Aim of the workTo assess health-related quality of life (HRQoL) and associated variables in Egyptian ankylosing spondylitis (AS) patients.Patients and methods50 male patients with AS and 50 age-matched controls were enrolled. Clinical and laboratory data were examined including history for peripheral arthritis. Visual analog scale (VAS), Bath AS disease activity index (BASDAI), AS disease activity score (ASDAS)-C-reactive protein (CRP) and ASDAS-erythrocyte sedimentation rate (ESR), Bath AS functional index (BASFI), Bath AS metrology index (BASMI) and AS quality of life (ASQoL). Spinal radiographs were graded by the modified Stoke AS spinal score (mSASSS).ResultsThe mean age of the patients was 33.1 ± 7.4 years and disease duration of 6.8 ± 3.1 years. The mean ASQoL score in patients was significantly higher (9.4 ± 3.8; 3–15) compared to the control. 26 (52%) patients had peripheral arthritis. Of these, 17 (65.4%) had hip involvement, 6 (23.1%) had knee, 5 (19.2%) had shoulder affection and 3 (11.5%) had ankle joint involvement. Patients with peripheral joint involvement had significantly higher ASQoL score than those without (11.4 ± 3.1 and 7.3 ± 3.4 respectively, p < 0.001). ASQoL significantly correlated with BASMI (p = 0.048), BASFI (p = 0.02), BASDAI (p = 0.01), ASDAS.CRP (p = 0.02) and ASDAS.ESR (p = 0.01). The multiple regression analysis to identify the independent variables associated with the ASQoL showed a significant association with peripheral joint involvement, BASDAI, ASDAS.ESR, ASDAS.CRP and BASFI scores.ConclusionAS is a chronic inflammatory disease that affects HRQoL especially with higher disease activity, functional disability, more peripheral joint involvement and lesser spinal mobility in Egyptian patients.     

Effectiveness of early colonoscopy in patients with colonic diverticular hemorrhage: A single-center retrospective cohort study

BACKGROUNDCurrent guidelines recommend colonoscopy within 24 h for acute lower gastrointestinal bleeding; however, the evidence in support for colonic diverticular hemorrhage (CDH) indications remains insufficient.AIMTo investigate the effectiveness of early colonoscopy on the length of hospital stay for CDH patients.METHODSWe conducted a single-center retrospective cohort study. Patients who underwent colonoscopy within 24 h of presentation (early group) were compared with those who underwent colonoscopy beyond 24 h of presentation (elective group). The primary outcome was the length of hospital stay, and secondary outcomes were the identification of stigmata of recent hemorrhage (SRH), rebleeding, red blood cell transfusion more than 4 units, and interventional radiology and abdominal surgery after colonoscopy.RESULTSWe identified 574 CDH cases. Patients were divided into the early (n = 328) and elective (n = 226) groups. After propensity score matching, 191 pairs were generated. The length of hospital stay did not significantly differ between the two groups (early group vs elective group; median, 7 vs 8 d; P = 0.10). The early group had a significantly high identification of SRH (risk difference, 11.6%; 95%CI: 2.7 to 20.3; P = 0.02). No significant differences were found in the rebleeding (risk difference, 4.7%; 95%CI: -4.1 to 13.5; P = 0.35), red blood cell transfusion more than 4 units (risk difference, 1.6%; 95%CI: -7.5 to 10.6; P = 0.82), and interventional radiology and abdominal surgery rate after colonoscopy (risk difference, 0.5%; 95%CI: -2.2 to 3.2; P = 1.00).CONCLUSIONEarly colonoscopy within 24 h, on arrival for CDH, could not improve the length of hospital stay.     

Health status and health-related quality of life associated with von Willebrand disease

Von Willebrand disease (VWD) is the commonest inherited disorder of hemostasis and the majority of women with this disorder experience excessive uterine bleeding. Yet very little information is available on the health-related quality of life (HRQL) in individuals with VWD. To test the a priori hypotheses that these individuals will have poorer HRQL than members of the general population, and that this burden of morbidity will correlate with the severity of VWD, a cross-sectional study was undertaken of a population-based cohort in a regional hemophilia program in Ontario, Canada. A survey was made of individuals over 13 years of age with VWD who self-reported their health status using a standard 15 item questionnaire. The responses were converted to levels in the Health Utilities Index Mark 2 (HUI2) and Mark 3 (HUI3) health status classification systems to form multi-element vectors from which single attribute morbidity and overall HRQL utility scores were determined. As a group, individuals with VWD were shown to have poorer HRQL than members of the general population and those with Type 2 disease carried a greater burden of overall morbidity than those with Type 1 disorder. Morbidity was evident mainly in the attributes of emotion, cognition with pain. A striking difference was observed between males and females, with the latter having overall HRQL utility scores similar to those reported previously for HIV positive, severe hemophiliacs. It is possible that this remarkable burden of morbidity reflects chronic iron deficiency associated with menorrhagia. A national study has been proposed to address this likelihood as it offers an opportunity for effective therapeutic intervention (iron supplementation) with a concomitant gain in health status and HRQL.     

Rifaximin in the management of colonic diverticular disease

Rifaximin is a rifamycin derivative that acts by inhibiting bacterial RNA synthesis. Since it is virtually unabsorbed after oral administration, its bioavailability within the GI tract is high, with intraluminal and fecal drug concentrations largely exceeding the minimum inhibitory concentration values observed in vitro against a broad spectrum of bacteria, including Gram-positive and Gram-negative bacteria, both aerobes and anaerobes. The GI tract, therefore, represents the primary therapeutic target and the disorders in which intestinal bacteria have a pathogenic role represent the main indication. This is the case with colonic diverticular disease. As a consequence, the broad antibacterial activity of rifaximin appears to be of value in the treatment of this clinical condition. Clinical trials have provided evidence of the substantial benefit of rifaximin in diverticular disease. Indeed, available data show the efficacy of the drug in achieving symptomatic relief in patients with uncomplicated disease. A therapeutic gain of approximately 30%, compared with fiber supplementation only, can be expected after cyclic administration of rifaximin for 12 months. However, its value in the prevention of inflammatory complications of the disease needs to be further explored. Recent studies have shown some evidence of synergy between rifaximin and mesalazine and suggest that a combined treatment could be worthwhile in selected subsets of patients with diverticular disease.     

Quality of life after colectomy for colonic inertia

Background Total abdominal colectomy (TAC) with ileorectal anastomosis represents the procedure of choice in patients with colonic inertia and relieves constipation in the majority of patients. The aim of this study was to assess postoperative long–term health related quality of life in these patients in relation to their functional outcome. Methods A consecutive series of patients with isolated colonic inertia who underwent TAC between 1993 and 1999 was identified from a clinical database and investigated in a cohort outcome study. Functional variables including the weekly number of bowel movements (BM), abdominal pain, bloating and distension, fecal incontinence, and the use of medications for BM assistance were assessed preoperatively and postoperatively. Main outcome measure was healthrelated quality of life assessed at follow–up using the SF–36 Health Survey. Results A total of 17 women with a mean age of 47.8 years (SD=14.3 years) were assessed and were followed postoperatively for 58.3±27.3 months. Preoperatively, all patients were constipated with less than one bowel movement per week, used laxatives, and experienced abdominal pain, bloating and distension. Postoperatively, all patients had some relief of constipation symptoms, with 3.7±2.8 bowel movements/day; 41% complained of abdominal pain, 65% of bloating, 29% required BM assistance, and 47% had occasional incontinence to gas or liquid stool. The SF–36 scores were significantly lower than those of the general population (p<0.005). In univariate regression analysis, postoperative abdominal pain was predictive for lower scores in general health and vitality and the need for BM assistance for lower scores in physical role functioning, social functioning, and emotional role limitations. Conclusions After TAC, quality of life is significantly reduced in patients with colonic inertia despite successful relief of symptoms of constipation. Postoperative pain and functional impairment are predictive of lower quality of life scores. Note This study was reported in part as an oral presentation at the Annual Meeting of the American Society of Colon and Rectal Surgeons, 2–8 June 2002, Chicago, USA, and as a poster at the Annual Meeting of the Association of Coloproctology of Great Britain and Ireland, Manchester, United Kingdom, 2–5 July 2002.     

Gastrointestinal quality of life in patients after anti reflux surgery

A subset of patients does not report improvement of symptoms or satisfaction after antireflux surgery. The aim of this study is to assess the effect of pre-existing depression as a factor in patient satisfaction and gastrointestinal quality of life index (GIQLI) outcomes after antireflux surgery. Patients undergoing antireflux surgery who had filled a preoperative quality of life score and had more than 1 year follow-up were included in this study. Based on available history and self-reported medication use, patients were divided in two groups: with depression (group A) and without depression (group B). Fifty-four patients with completed preoperative GIQLI questionnaire were contacted for this study; 32 (59%) patients completed the postoperative questionnaire. Seven patients (22%) had psychological disorder (group A) in the form of depression The GIQLI in groups A and B increased significantly from 64.4 ± 17.3 and 89.6 ± 18.6 to 88.6 ± 23.7 ( P  < 0.001) and 102.2 ± 18.6 ( P  = 0.02), respectively, after the surgery. There was significant improvement in the quality of life in patients after antireflux surgery based on the GIQLI assessment. This improvement was also reported in patients with history of depression.     

Proxy‐reported health‐related quality of life of patients with juvenile idiopathic arthritis: The pediatric rheumatology international trials organization multinational quality of life cohort study

Objective

To investigate the proxy‐reported health‐related quality of life (HRQOL) and its determinants in patients with juvenile idiopathic arthritis (JIA).

Methods

In this multinational, multicenter, cross‐sectional study, HRQOL of patients with JIA was assessed through the Child Health Questionnaire (CHQ) and was compared with that of healthy children of similar age from the same geographic area. Potential determinants of HRQOL included demographic data, physician's and parent's global assessments, measures of joint inflammation, Childhood Health Assessment Questionnaire (CHAQ), and erythrocyte sedimentation rate.

Results

A total of 6,639 participants (3,324 with JIA and 3,315 healthy) were enrolled from 32 countries. The mean ± SD physical and psychosocial summary scores of the CHQ were significantly lower in patients with JIA than in healthy children (physical: 44.5 ± 10.6 versus 54.6 ± 4.0, P < 0.0001; psychosocial: 47.6 ± 8.7 versus 51.9 ± 7.5, P < 0.0001), with the physical well‐being domain being most impaired. Patients with persistent oligoarthritis had better HRQOL compared with other subtypes, whereas HRQOL was similar across patients with systemic arthritis, polyarthritis, and extended oligoarthritis. A CHAQ score >1 and a pain intensity rating >3.4 cm on a 10‐cm visual analog scale were the strongest determinants of poorer HRQOL in the physical and psychosocial domains, respectively.

Conclusion

We found that patients with JIA have a significant impairment of their HRQOL compared with healthy peers, particularly in the physical domain. Physical well‐being was mostly affected by the level of functional impairment, whereas the intensity of pain had the greatest influence on psychosocial health.     

Health-related quality of life after elective surgery

Objective:  To examine the responsiveness of the 36-Item Short Form Health Survey (SF-36) to clinical changes in three surgical groups and to study how health-related quality of life (HRQL) changes with time among patients who undergo total hip arthroplasty, thoracic surgery for treatment of non-small-cell lung cancer, or abdominal aortic aneurysm (AAA) repair. Design:  Prospective cohort study with serial evaluations of HRQL preoperatively and at 1, 6, and 12 months after surgery. Setting:  University tertiary care hospital. Patients:  Of 528 patients, more than 50 years of age, who were admitted for these elective procedures, 454 (86%) provided preoperative health status data and are members of the study cohort. At 12 months after surgery, 439 (93%) of the cohort was successfully contacted and 390 (90%) provided follow-up interviews. Measurements and main results:  The Medical Outcomes Study SF-36, the Specific Activity Scale, five validated health transition questions, and a 0 to 100 scale measure of global health were used to assess changes in health status at 1, 6, and 12 months after surgery. Change in health status as measured by the SF-36 demonstrated that physical function and role limitations due to physical health problems were worse 1 month after these three surgeries. However, by 6 months after surgery, most patients experienced significant gains in the majority of the dimensions of health, and these gains were sustained at 12 months after surgery. Longitudinal changes in the SF-36 were positively associated with responses to the five health transition questions, to changes on the Specific Activity Scale and global health rating question, and to clinical parameters for persons who had AAA repair. These findings indicate that the SF-36 has evidence of validity and is responsive to expected changes in HRQL after elective surgery for these procedures. Conclusions:  For the total hip arthroplasty patients, responsiveness was greatest for the SF-36 scales that measure physical constructs. However, for the two other procedures and at various points of recovery, significant changes were observed for all eight subscales, suggesting that responsiveness was dependent on the type of surgery and the timing of follow-up, and that multidimensional measures are needed to fully capture changes in HRQL after surgery. Funded in part by a grant from the Agency for Health Care Policy and Research (1RO1-HS06573). Dr. Mangione is the recipient of a Clinical Investigator Award (1K08-AG00605) from the National Institute on Aging, and is an awardee of the Robert Wood Johnson Foundation Generalist Physicians Faculty Scholars Program (029250).     

Health‐related quality of life in adolescents with juvenile idiopathic arthritis

Objective

To describe the health‐related quality of life (HRQOL) of adolescents with juvenile idiopathic arthritis (JIA), and to examine the usefulness of the Juvenile Arthritis Quality of Life Questionnaire (JAQQ) in a UK context. It was hypothesized that HRQOL would decrease with worsening disease and disability.

Methods

Patients with JIA ages 11, 14, and 17 years were recruited from 10 major rheumatology centers. HRQOL was measured using the JAQQ. Other data were core outcome variables including the Childhood Health Assessment Questionnaire, demographic characteristics, arthritis‐related knowledge, and satisfaction with health care.

Results

Questionnaires were completed by 308 adolescents. One‐fifth had persistent oligoarthritis. Median disease duration was 5.7 years (range <1–16 years). The JAQQ was shown to have good psychometric properties when used in the UK, but was not without limitations. HRQOL of adolescents with JIA was less than optimal, particularly in the domains of gross motor and systemic functioning. Items most frequently rated as adolescents' biggest psychological problems were “felt frustrated” and “felt depressed,” rated by 30.2% and 23.4%, respectively. These were particularly problematic for the 17‐year‐olds, with 39% reporting frustration as one of their biggest problems and 63.6% reporting depression. Variation in the adolescent JAQQ scores was explained by functional disability, pain, and disease activity.

Conclusion

JIA can have a significant adverse effect on the HRQOL of adolescents. The JAQQ is a useful tool to assess the HRQOL of UK adolescents with JIA, but there is need for improved measures that incorporate developmentally appropriate issues.

     

Sepsis caused by endoscopic clipping for colonic diverticular bleeding： A rare complication

We herein report the rare complication of sepsis caused by endoscopic clipping for colonic diverticular bleeding. A 78-year-old man with a 12-h history of near syncope and painless hematochezia was admitted to our hospital. Following the transfusion of 4 U of blood and continued hematochezia, a colonoscopy was performed. Active bleeding was seen as continuous arterial spurting from a single diverticulum located in the middle ascending colon. This diverticulum was seamed by four endoclips. The next day, the patient became febrile with a temperature of 39.2℃. Laboratory data included a white blood cell count of 18100/mm^3 and a C-reactive protein level of 3.4 mg/dL. He was diagnosed with sepsis since Escherichia coli was detected in the blood culture. Antibiotics were started. Four days later his fever had improved and laboratory data improved 9 d later.     

Impact of fatigue on health‐related quality of life in rheumatoid arthritis

Objective

To multidimensionally assess fatigue in rheumatoid arthritis (RA) and to evaluate the impact of fatigue on health‐related quality of life (HRQOL).

Methods

The study was conducted in 1999 among 490 RA patients with varying disease duration. Fatigue was measured with the Multidimensional Fatigue Inventory (MFI‐20) and HRQOL with a validated Dutch version of the RAND 36‐Item Health Survey. We evaluated the impact of fatigue on HRQOL by multiple linear regression analyses taking into account RA‐related pain and depressive symptoms.

Results

Different aspects of fatigue selectively explained different dimensions of HRQOL. The MFI‐20 was entered last to the linear regression models, resulting in an additional increase of explained variance of 1% (mental health) to 14% (vitality).

Conclusion

The multidimensional portrayal of RA‐related fatigue can be used to develop intervention strategies targeted to specific aspects of fatigue. Fatigue, supplementary to RA‐related pain and depressive symptoms, appears to be a feasible and treatable target in the clinical management of RA to increase HRQOL.