P113 - Interactions among treatment trends, quality of life and disease activity in inflammatory bowel disease (IBD)

Abstract

Introduction: In an outpatient setting, Crohn’s disease (CD) is often considered to be more problematic to manage than Ulcerative colitis (UC). We examined local data to determine whether this held true Methods: As part of a larger management trial, 64 outpatients with CD and UC attending a tertiary referral hospital were recruited over 7 months. Data collected on each patient at study entry included current medication, disease activity (CDAI, SCCAI), anxiety and depression (HADS), quality of life (QoL) (SF12), age, gender and clinical characteristics. Treatments and outcomes were compared for patients with CD and UC utilising non parametric tests. Results: 33 patients had UC and 31 CD. A higher proportion of patients with UC had active disease at recruitment compared to CD (58% vs. 13%; p = 0.007). Despite this, those with UC were less likely to be on immunomodulators (36% vs. 77%; p = 0.0012) and were receiving oral steroids only at the same rate (12% vs. 10%; p = 1.0). As expected, a higher proportion of UC patients received 5ASA therapy (85% vs. 58%; p = 0.0257); but unexpectedly they were also being prescribed antidepressant therapy at a significantly higher rate than those with CD (24% vs. 3%; p = 0.027). Overall, scores for anxiety, depression, physical and mental QoL did not differ by diagnosis. Although when all subjects were stratified for disease activity, those with active disease had poorer physical QoL (40.6 vs. 48.4, p = 0.008), whereas scores for anxiety, depression and mental QoL did not vary with disease activity. Conclusion: Our data suggest a significantly higher rate of psychological co-morbidity in UC as compared to CD that cannot simply be attributed to oral steroid therapy. While our data need independent confirmation, the potential under-treatment of UC (or over-treatment of CD) patients needs to be addressed to ensure a level of care appropriate to both disease activity and psychological co-morbidities.