Bowel Diseases

The aim of the present study was to investigate the Quality of Life of patients suffering from IBD and the factors that might be affecting it.
The idiopathic Inflammatory Bowel Diseases (IBD) are chronic nosological entities negatively affecting the Quality Of Life of patients suffering
from IBD in relation to the total population. Evaluating their Quality of Life is the basic constitution for evaluating their needs and for designing
the suitable health care system to be provided. In the province of Larnaca the SIBDQ questionnaire translated in the Greek language was used
to evaluate 100 patients suffering from Ulcerative Colitis and Crohn’s disease. We studied the Quality of Life as a dependent variable correlated
with the independent variables that are the demographic and general characteristics of this patient group.

Objective. The objective of this study was to explore the experience of patients who had stoma surgery to treat cancer in order to explicate why problems associated with stoma surgery are not decreasing despite technical improvements in stoma care.


Design. A longitudinal design was used in order to capture the process of preparing for surgery and dealing with its aftermath. Participants were interviewed using a semi-structured protocol on three occasions; 1-2 weeks before surgery (eight participants), 1-2 weeks after surgery (seven participants), and 3 months after surgery (four participants).


Method. Transcripts were analysed guided by the procedures of grounded theory. This involved developing categories from the data and linking them together to form a conceptual understanding of our participants' experience.


Results. Lowered personal control was the most important concept to emerge from the analysis. We identified perceived causes of lowered control, its mitigating factors, the strategies used to manage this experience and the consequences of these processes.


Conclusions. We make three recommendations based on the conclusion that improvements could be implemented in the psychological aspects of stoma care and, in particular, the enabling of patient perceived self-efficacy. First, improvements could be made in doctor-patient communication with doctors becoming more aware of their psychological impact on patients. Second, specialist stoma care nurses could be trained to recognize patients with dysfunctional self-efficacy beliefs and/or delayed adaptation. Finally, we identify a need for more prolonged practical emotional support for at least some stoma out-patients.

Introduction: Adalimumab is an anti-tumour necrosis factor (anti-TNF) monoclonal antibody and an important part of the treatment regime for autoimmune conditions including inflammatory bowel disease. We present a case of adalimumab induced pleuropericarditis and discuss the diagnosis challenges we faced.
Case History: A 22-year-old male presented to the emergency department with 3 days history of headache, malaise, fever and right-sided chest pain. He was diagnosed with ulcerative colitis 8 months ago but failed to respond to mesalazine, requiring high dose steroids to induce disease remission. His mesalazine was stopped after 4 months and he was initiated on adalimumab 2 months prior to the current presentation. At presentation, he had a temperature of 38.7 °C (101.6 °F) but no other physical signs. His inflammatory markers were raised, and the chest x-ray was clear. He was started on empirical intravenous antibiotics on suspicion of the underlying infective process. On day 4 the patient developed a new pleural rub and crepitations on both lung bases. An urgent echocardiogram and computed tomography scan of the thorax abdomen and pelvis revealed pleural effusion and a 1.8 cm diameter pericardial effusion. Extensive investigation including virology screen, autoimmune screen and pleural fluid analysis were normal.
Diagnosis, Management and Outcome: This case was discussed in a multidisciplinary meeting. A diagnosis of pleuropericarditis secondary to adalimumab was made. Adalimumab and antibiotics were stopped, and he was started on a course of oral steroids. The patient responded well to the treatment and his symptoms resolved.
Conclusion: Rare drug toxicity should be part of differential diagnosis, especially in young patients with unusual presentation. An early multidisciplinary approach is crucial for a positive outcome. The patient should be actively involved in decision making to improve long term outcome.

Objectives: The aim of this study was to apply qualitative techniques to assimilate data on patient experience and attitudes during MR colonography (MRC) and colonoscopy (CC). Methods: 18 patients (11 male, 7 female, median age 40.5 years), 10 of which had known colonic inflammatory bowel disease (IBD) and 7 who were under investigation for suspected colonic neoplasia (non-IBD), underwent MRC and conventional CC. Semi-structured interviews were performed to assimilate test experiences and preferences, and themes were extracted using thematic analysis. Results: Thematic analysis identified three main themes: (i) physical experience, (ii) information provision and (iii) overall preference. Patients expressed mixed views about the physical experience of MRC but specifically identified water filling, breath holding and lying still as problematic. Anxiety was expressed regarding potential incontinence. Scanner noise interfered with the understanding of instructions, particularly amongst non-IBD patients. Non-IBD patients expressed greater anxiety over the delay in receiving the MRC report than IBD patients. In general MRI was considered as the more informative and safer investigation. Patients reported more physical discomfort during CC (notably IBD patients) related to air insufflation and colonoscopic manipulation but were more satisfied with the feedback they received. 10 patients (56%) stated an overall preference for MRC and 5 (28%) preferred CC. Reasons for preferences stated by the patients included discomfort, speed of the test, safely, perceived diagnostic ability and the ability to take biopsies. Conclusion: Experiences of MRC and CC are complex and influenced by clinical indication. Individuals place different weightings on the relative importance of test attributes including discomfort, noise, immobility, feedback, safety and fear of incontinence and this defines overall preference.