Crohns Disease

There are very few studies on quality of life issues in Crohn's disease. The issues that impact principally on quality of life are as follows:

1. The fear of recurrent Crohn's disease.

2. The fear of ill health and compromised work prospects.

3. Perianal disease often with psychosexual complications.

4. Impact of bodily image from multiple scars and anorectal sepsis and stomas.

5. Sexual morbidity and infertility.

6. A permanent stoma.

7. Incontinence.

In Crohn's disease there are often long periods of quiescence between successful surgical treatments. Nevertheless, Crohn's disease is associated with potential life-long disability. Factors which influence recurrence in ileal Crohn's disease are:

1. Early onset of disease.

2. Cigarette smoking.

3. Diffuse small-bowel disease.

4. Possibly a narrow ileocolonic anastomosis. Diffuse small bowel disease has a high recurrence rate and a high reoperation rate [31], which is associated with a high incidence of interpersonal morbidity, loss of time from work, fear of repeated operations and the use of medical treatment associated with unpleasant side effects [32]. Diffuse small-bowel disease also has a major impact on social activities, fertility and normal home family life.

Crohn's disease is associated with a higher risk of losing one's job, early retirement or modification of employment. Patients with Crohn's disease have fewer children, than age and sex-matched normal subjects. Quality of life in Crohn's disease is generally associated with relapse, which compromises work, leisure and social activities [33, 34]. Quality of life is often compromised by growth retardation especially in diffuse disease.

The issues we found as having a major impact on quality of life in Crohn's disease were as follows:

1. Bowel frequency

2. Appetite and diet

3. Sleep

4. Dependence on others

5. Mental health

6. Psychosexual morbidity.

We found that during remission, quality of life in Crohn's disease did not differ from controls. In comparison, patients with active disease had a compromised quality of life. In Crohn's disease the impact of the underlying disease process on quality of life is largely influenced by individual's personality and motivation. Males seem to be more seriously affected than women. Generally minimally invasive surgery in Crohn's disease is associated with less of an impact on quality of life, particularly strictureplasty and segmental colonic resection [35].

The main message in managing Crohn's disease is the need for close collaboration between the gas-troenterologists, surgeons, healthcare professionals and the patient and their families. Patients with Crohn's disease do better if they are provided with regular professional nutritional advice, appropriate medical therapy and the support of clinical nurse specialists. It is essential for surgeons involved in the management of Crohn's disease to spend time in the counselling process. There are fundamental surgical issues which also affect quality of life. In high-risk individuals, a proximal defunctioning stoma is always advised. Anastomoses should be avoided in the presence of severe sepsis because of the risk of breakdown. It is paramount that the surgeon preserves as much of the small bowel as possible and avoids major complications. Appropriate attention to these issues will have a considerable impact on the overall quality of life of patients with intestinal Crohn's disease.

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