Chronic intestinal pseudo-obstruction and enteric dysmotility : aspects on patients' health-care use, coping capacity and quality of life

Aims of the thesis: To measure health care consumption before and after the introduction of a specialized day-care unit and to investigate if patients with chronic intestinal pseudo-obstruction (CIP) differ from those with enteric dysmotility (ED) regarding clinical features, self-reported functional status, health-related quality of life (HRQL), and sense of coherence (SOC).

Methods: Retrospective analysis of medical records for 125 and 54 patients with CIP or ED (paper I-II). Prospective collection of data from 54 patients with CIP or ED using 4 self-reported questionnaires: Sense of Coherence (SOC) (paper IV), Sickness Impact Profile (SIP), Swedish Health-Related Quality of Life Questionnaire (SWED-QUAL), and Gastrointestinal Symptom Rating Scale (GSRS) (paper III-IV).

Results: Survival among patients with CIP was significantly worse (p<0.05) and they more often (49%) needed parenteral nutrition than patients with ED (14%). Time in hospital care was reduced from 39.4 to 3.3 days per patient and year and costs from $32,698 during traditional health-care services to $9,681 after introducing the day-care unit (p<0.002). Patients with CIP reported significantly greater functional impairment in the aggregated physical dimension of SIP (p<0.01) and significantly poorer general health (p<0.01) compared to those with ED. We found no difference in SOC between patients with CIP and ED.

Conclusions: CIP and ED differ with respect to severity of measurable physiological derangement, nutritional needs, long-term prognosis, functional status and general health perception. Individually tailored care at a specialized day-care unit leads to a substantially decreased need for hospital stays and lower costs.

List of scientific papers

I. Lindberg G, Iwarzon M, Tornblom H. (2009). Clinical features and long-term survival in chronic intestinal pseudo-obstruction and enteric dysmotility. Scand J Gastroenterol. 44(6):692-9.
https://pubmed.ncbi.nlm.nih.gov/19308797

II. Iwarzon M, Gardulf A, Lindberg G. (2008). Health care use in patients with chronic intestinal dysmotility before and after introducing a specialized day-care unit. Clin Gastroenterol Hepatol. 6(8):893-8.
https://pubmed.ncbi.nlm.nih.gov/18524687

III. Iwarzon M, Gardulf A, Lindberg G. (2009). Functional status, health-related quality of life and symptom severity in patients with chronic intestinal pseudo-obstruction and enteric dysmotility. Scand J Gastroenterol. 44(6):700-7.
https://pubmed.ncbi.nlm.nih.gov/19308798

IV. Iwarzon M, Lindberg G. (2009). Coping ability of patients with chronic intestinal pseudo-obstruction and enteric dysmotility. [Manuscript]