Sepsis during short bowel syndrome hospitalizations:Identifying trends,disparities,and clinical outcomes in the United States

BACKGROUND Short bowel syndrome(SBS)hospitalizations are often complicated with sepsis.There is a significant paucity of data on adult SBS hospitalizations in the United States and across the globe.AIM To assess trends and outcomes of SBS hospitalizations complicated by sepsis in the United States.METHODS The National Inpatient Sample was utilized to identify all adult SBS hospitalizations between 2005-2014.The study cohort was further divided based on the presence or absence of sepsis.Trends were identified,and hospitalization characteristics and clinical outcomes were compared.Predictors of mortality for SBS hospitalizations complicated with sepsis were assessed.RESULTS Of 247097 SBS hospitalizations,21.7%were complicated by sepsis.Septic SBS hospitalizations had a rising trend of hospitalizations from 20.8%in 2005 to 23.5%in 2014(P trend<0.0001).Compared to non-septic SBS hospitalizations,septic SBS hospitalizations had a higher proportion of males(32.8%vs 29.3%,P<0.0001),patients in the 35-49(45.9%vs 42.5%,P<0.0001)and 50-64(32.1%vs 31.1%,P<0.0001)age groups,and ethnic minorities,i.e.,Blacks(12.4%vs 11.3%,P<0.0001)and Hispanics(6.7%vs 5.5%,P<0.0001).Furthermore,septic SBS hospitalizations had a higher proportion of patients with intestinal transplantation(0.33%vs 0.22%,P<0.0001),inpatient mortality(8.5%vs 1.4%,P<0.0001),and mean length of stay(16.1 d vs 7.7 d,P<0.0001)compared to the non-sepsis cohort.A younger age,female gender,White race,and presence of comorbidities such as anemia and depression were identified to be independent predictors of inpatient mortality for septic SBS hospitalizations.CONCLUSION Septic SBS hospitalizations had a rising trend between 2005-2014 and were associated with higher inpatient mortality compared to non-septic SBS hospitalizations.

Navigating Long-Term Management Challenges in Short Bowel Syndrome: A Case Report of Chronic Intestinal Failure Complicated by Kidney Dysfunction

The most common cause of intestinal failure is short bowel syndrome (SBS), occurring as a result of a small functional intestine length, usually less than 200 cm, leading to intestinal malabsorption. A 59-year-old female with a past medical history of Crohns disease status post total colectomy with ileostomy over 20 years ago came to the hospital due to progressive weakness. Despite medical management, the patient had high ileostomy output, leading to electrolyte disbalance, metabolic acidosis, dehydration, and progressive kidney decline. Due to the high dependence on continuous fluid supplementation, it was decided to place a port for parenteral hydration to maintain fluid replacements and homeostasis after discharge. Prompt initiation of parenteral fluid replacement and close follow-up on patients with ileostomy and intestinal failure is strongly recommended to avoid complications and prevent intestinal, liver, or kidney transplants.

Chronic intestinal failure and short bowel syndrome in Crohn’s disease

Chronic intestinal failure(CIF)is a rare but feared complication of Crohn’s disease.Depending on the remaining length of the small intestine,the affected intestinal segment,and the residual bowel function,CIF can result in a wide spectrum of symptoms,from single micronutrient malabsorption to complete intestinal failure.Management of CIF has improved significantly in recent years.Advances in home-based parenteral nutrition,in particular,have translated into increased survival and improved quality of life.Nevertheless,60%of patients are permanently reliant on parenteral nutrition.Encouraging results with new drugs such as teduglutide have added a new dimension to CIF therapy.The outcomes of patients with CIF could be greatly improved by more effective prevention,understanding,and treatment.In complex cases,the care of patients with CIF requires a multidisciplinary approach involving not only physicians but also dietitians and nurses to provide optimal intestinal rehabilitation,nutritional support,and an improved quality of life.Here,we summarize current literature on CIF and short bowel syndrome,encompassing epidemiology,pathophysiology,and advances in surgical and medical management,and elucidate advances in the understanding and therapy of CIF-related complications such as catheter-related bloodstream infections and intestinal failure-associated liver disease.

Management of patients with a short bowel

There are two common types of adult patient with a short bowel, those with jejunum in continuity with a functioning colon and those with a jejunostomy. Both groups have potential problems of undernutrition, but this is a greater problem in those without a colon, as they do not derive energy from anaerobic bacterial fermentation of carbohydrate to short chain fatty acids in the colon. Patients with a jejunostomy have major problems of dehydration, sodium and magnesium depletion all due to a large volume of stomal output. Both types of patient have lost at least 60 cm of terminal ileum and so will become deficient of vitamin B(12). Both groups have a high prevalence of gallstones (45%) resulting from periods of biliary stasis. Patients with a retained colon have a 25% chance of developing calcium oxalate renal stones and they may have problems with D(-) lactic acidosis. The survival of patients with a short bowel, even if they need long-term parenteral nutrition, is good.

Gut hormones, and short bowel syndrome: The enigmatic role of glucagon-like peptide-2 in the regulation of intestinal adaptation

Short bowel syndrome （SBS） refers to the malabsorption of nutrients, water, and essential vitamins as a result of disease or surgical removal of parts of the small intestine. The most common reasons for removing part of the small intestine are due to surgical intervention for the treatment of either Crohn＇s disease or necrotizing enterocolitis. Intestinal adaptation following resection may take weeks to months to be achieved, thus nutritional support requires a variety of therapeutic measures, which include parenteral nutrition. Improper nutrition management can leave the SBS patient malnourished and/or dehydrated, which can be life threatening. The development of therapeutic strategies that reduce both the complications and medical costs associated with SBS/long-term parenteral nutrition while enhancing the intestinal adaptive response would be valuable. Currently, therapeutic options available for the treatment of SBS are limited. There are many potential stimulators of intestinal adaptation including peptide hormones, growth factors, and neuronally-derived components. Glucagon-like peptide-2 （GLP-2） is one potential treatment for gastrointestinal disorders associated with insufficient mucosal function. A significant body of evidence demonstrates that GLP-2 is atrophic hormone that plays an important role in controlling intestinal adaptation. Recent data from clinical trials demonstrate that GLP-2 is safe, well-tolerated, and promotes intestinal growth in SBS patients. However, the mechanism of action and the localization of the glucagon-like peptide-2 receptor （GLP-2R） remains an enigma. This review summarizes the role of a number of mucosal-derived factors that might be involved with intestinal adaptation processes; however, this discussion primarily examines the physiology, mechanism of action, and utility of GLP-2 in the regulation of intestinal mucosal growth.

Concise review on short bowel syndrome: Etiology, pathophysiology, and management

Adults have approximately 20 feet of small intestine,which is the primary site for absorbing essential nutrients and water.Resection of the intestine for any medical reason may result in short bowel syndrome(SBS),leading to loss of major absorptive surface area and resulting in various malabsorption and motility disorders.The mainstay of treatment is personalized close dietary management.Here we present SBS with its pathophysiology and different nutritional management options available.The central perspective of this paper is to provide a concise review of SBS and the treatment options available,along with how proper nutrition can solve major dietary issues in SBS and help patients recover faster.

Glucagon-like peptide-2 analogues for Crohn’s disease patients with short bowel syndrome and intestinal failure

Short bowel syndrome(SBS)with intestinal failure(IF)is a rare but severe complication of Crohn’s disease(CD),which is the most frequent benign condition that leads to SBS after repeated surgical resections,even in the era of biologics and small molecules.Glucagon-like peptide-2 analogues have been deeply studied recently for the treatment of SBS-IF.These drugs have a significant intestinotrophic effect and the potential to reduce the chronic dependence of SBSIF patients on parenteral support or nutrition.Teduglutide has been approved for the treatment of SBS-IF,and apraglutide is currently in clinical development.The use of these drugs was examined with a focus on their use in CD patients.

Where are we at with short bowel syndrome and small bowel transplant?

Intestinal failure can be defined as the critical reduction of functional gut mass below the minimal amount necessary for adequate digestion and absorption to satisfy body nutrient and fluid requirements in adults or children.Short bowel syndrome(SBS)is characterized by a state of malabsorption following extensive resection of the small bowel.SBS may occur after resection of more than 50%and is certain after resection of more than 70%of the small intestine,or if less than 100 cm of small bowel is left.Several treatment modalities other than total parenteral nutrition,including hormones(recombinant human growth hormone,glucagon-like peptide-2)and tailoring surgeries(Bianchi procedure,serial transverse enteroplasty),had been proposed,however these were either experimental or inefficient.Small bowel transplant is a rather new approach for SBS.The once feared field of solid organ transplantation is nowadays becoming more and more popular,even in developing countries.This is partially secondary to the developments in immunosuppressive strategy.In this regard,alemtuzumab deserves special attention.There are more complex surgeries,such as multivisceral transplantation,for multi-organ involvement including small bowel.This latter technique is relatively new when compared to small bowel transplant,and is performed in certain centers worldwide.In this review,an attempt is made to give an insight into small bowel syndrome,small bowel transplantation,and related issues.

Alternative technique to save ischemic bowel segment in management of neonatal short bowel syndrome: A case report

BACKGROUND Congenital short bowel syndrome(SBS)associated with malrotation,gut volvulus and jejuno-ileal atresia is a very rare condition.It is a severe challenge for surgeons to preserve residual ischemic bowel segment in the management of short bowel syndrome,especially in neonates.CASE SUMMARY We report a newborn baby with gut malrotation associated with jejuno-ileal atresia,congenital SBS and jejunal volvulus.Hematemesis and abdominal distention were noted.At laparotomy,malrotation associated with jejuno-ileal atresia,congenital SBS and jenunal volvulus was confirmed.The total length of the small bowel was 63 cm with proximal jejunal bowel segment measuring 38 cm,including 18 cm necrotic segment below the Treitz’s ligament and 20 cm severe ischemic segment.The distal part of the small bowel was 25 cm in length and only about 0.8 cm in diameter.Ladd’s procedure,necrotic segment resection and end-to-back duodeno-ileal anastomosis were performed.The residual severe ischemic jejunum was preserved with single proximal stoma and distal end closure.Three months later,to restore the continuity of the isolated gut segment,end-to-end duodeno-jejunal and jejuno-ileal anastomosis was performed.The entire functional small bowel length increased to 80 cm.Intravenous fluid therapy and parenteral nutrition were discontinued on the 10th day postoperatively.Twelve months later,her body weight was 9.5 kg.CONCLUSION Isolation of severe ischemic bowel segment and staged anastomosis to restore the gut continuity for infants with SBS are safe and feasible.

Surgeon's perspective on short bowel syndrome: Where are we?

Short bowel syndrome(SBS) is due to a massive loss of small bowel: the reduction of gut function is below the minimum necessary to maintain health(in adults) and growth(in children) so intravenous supplementation is required. Parenteral nutrition represents the milestone of treatment and surgical attempts should be limited only when the residual bowel is sufficient to increase absorption, reducing diarrhea and slowing the transit time of nutrients, water and electrolytes. The surgical techniques lengthen the bowel(tapering it) or reverse a segment of it: developed in children, nowadays are popular also among adults. The issue is mainly represented by the residual length of the small bowel where ileum has shown increased adaptive function than jejunum, but colon should be considered because of its importance in the digestive process. These concepts have been translated also in intestinal transplantation, where a colonic graft is nowadays widely used and the terminal ileum is the selected segment for a livingrelated donation. The whole replacement by a bowel or multivisceral transplant is still affected by poor long term outcome and must be reserved to a select population of SBS patients, affected by intestinal failure associated with irreversible complications of parenteral nutrition.

Rehabilitation therapy for short bowel syndrome

OBJECTIVE: To investigate the effect of rehabilitation therapy for short bowel syndrome on patient nutritional status and intestinal adaptation. METHODS: The rehabilitation therapy included enteral or parenteral nutrition, glutamine, recombinant human growth hormone and rehabilitative diet. From January 1997 to July 2000, twenty - seven patients with short bowel syndrome received the treatment. The average age of the patients was 38.5 +/- 19.3 years, and the length of residual small intestine ranged from 15 to 80 cm, with an average of 46.8 +/- 23.4 cm. The ileocecal valve was preserved in 14 cases, and the average time between the onset of short bowel syndrome and the rehabilitation therapy was 86 +/- 105 days. RESULTS: After the treatment, nutritional status of the patients improved markedly, and intestinal absorptive capacity improved. Eight patients were followed up for more than 2 years, among whom 4 (50%) were weaned from total parenteral nutrition. Thirteen patients were followed up for more than 1 year, and 10 patients (76.9%) were weaned from total parenteral nutrition. CONCLUSIONS: Rehabilitation therapy for short bowel syndrome can improve patient nutritional status effectively and promote intestinal adaptation, providing a new hope for these patients. The therapeutic effects are related to the length of the residual small intestine, patients age and duration between massive intestinal resection and start of the treatment. Early initiation of rehabilitation therapy promotes intestinal adaptation and increases patients ability to wean from total parenteral nutrition.

短肠综合征患儿小肠移植术后早期移植肠康复的护理

总结5例各种原因所致短肠综合征患儿小肠移植术后早期移植肠康复的护理。针对儿童小肠移植手术复杂、术后并发症多、营养不良、心理应激、移植肠造口居家管理等问题,采取建立促进移植肠康复多学科协作团队;做好移植肠早期并发症的预防与护理;实施移植肠分阶段营养支持与护理;稳定患儿情绪配合移植肠康复的治疗与护理;开展患儿家长移植肠造口居家管理技能培训及考核等护理措施。经过积极治疗和护理,5例患儿术后早期移植肠功能顺利康复,出院后按时复诊;术后3~4个月均如期完成“回肠造口还纳术”,随访4~12个月,恢复良好。

胰高血糖素样肽-1受体激动剂在儿童患者中的临床应用进展

胰高血糖素样肽-1受体激动剂(GLP-1RA)在成人2型糖尿病的治疗中已有广泛应用,近年来的研究结果表明,GLP-1RA也可用于儿童肥胖和短肠综合征的治疗。本篇综述主要关注GLP-1RA在儿童患者中的临床应用进展。GLP-1RA通过改善胰岛素敏感性、减轻体重、降低血压和降低代谢综合征发生风险来改善儿童肥胖患者的代谢异常和心血管疾病风险。在短肠综合征中,GLP-1RA可增加肠道对养分的吸收,刺激胰岛素分泌,促进葡萄糖的利用和减少外源性葡萄糖的使用,增加脂肪的利用。GLP-1RA虽在临床应用中具有良好的安全性和耐受性,但也存在低血糖、恶心和呕吐、胰腺炎和甲状腺癌等风险,故需要密切监测患者的不良反应,进一步开展更加系统和深入的研究。

Effect of bowel rehabilitative therapy on structural adaptation of remnant small intestine: animal experiment

AIM: To investigate the individual and the combined effects of glutamine, dietary fiber, and growth hormone on the structural adaptation of the remnant small bowel. METHODS: Forty-two adult male Sprague-Dawley rats underwent 85% mid-small bowel resection and received total parenteral nutrition (TPN) support during the first three postoperational days.From the 4th postoperational day, animals were randomly assigned to receive 7 different treatments for 8 days: TPNcon group, receiving TPN and enteral 20 g x L(-1) glycine perfusion; TPN+Gln group, receiving TPN and enteral 20 g x L(-1) glutamine perfusion; ENcon group, receiving enteral nutrition (EN) fortified with 20 g x L(-1) glycine; EN+Gln group, enteral nutrition fortified with 20 g x L(-1) glutamine; EN+Fib group, enteral nutrition and 2 g x d(-1) oral soybean fiber; EN+GH group, enteral nutrition and subcutaneous growth hormone (GH) (0.3 IU) injection twice daily; and ENint group, glutamine-enriched EN, oral soybean fiber, and subcutaneous GH injection. RESULTS: Enteral glutamine perfusion during TPN increased the small intestinal villus height (jejunal villus height 250 microm +/- 29 microm in TPNcon vs 330 microm +/- 54 microm in TPN+Gln, ileal villus height 260 microm +/- 28 microm in TPNcon vs 330 microm +/- 22 microm in TPN+Gln, P【0.05) and mucosa thickness (jejunal mucosa thickness 360 microm +/- 32 microm in TPNcon vs 460 microm +/- 65 microm in TPN+Gln, ileal mucosa thickness 400 microm +/- 25 microm in TPNcon vs 490 microm +/- 11 microm in TPN+Gln,P【 0.05) in comparison with the TPNcon group. Either fiber supplementation or GH administration improved body mass gain (end body weight 270 g +/- 3.6g in EN+Fib, 265.7 g +/- 3.3 g in EN+GH, vs 257 g +/- 3.3 g in ENcon, P【 0.05), elevated plasma insulin-like growth factor (IGF-I) level (880 microg x L(-1). 52 microg x L-(-1) in EN+Fib,1200 microg x L(-1). 96 microg x L-(-1) in EN +/- GH, vs 620 microg x L(-1).43 microg x L-(-1) in ENcon, P【 0.05), and increased the villus height (jejunum 560 microm +/- 44 microm in EN +/- Fib, 530 microm +/- 30 microm in EN +/- GH, vs 450 microm +/- 44 microm in ENcon, ileum 400 microm +/- 30 microm in EN+Fib, P【0.05) and the mucosa thickness (jejunum 740 microm +/- 66 microm in EN +/- Fib, 705 microm +/- 27 microm in EN +/- GH, vs 608 microm +/- 58 microm in ENcon, ileum 570 microm +/- 27 microm in EN +/- Fib, 560 microm +/- 56 microm in remnant jejunum and ileum. Glutamine-enriched EN produced little effect in body mass, plasma IGF-I level, and remnant small bowel mucosal structure. The ENint group had greater body mass (280 g +/- 2.2g), plasma IGF-I level (1450 microg x L(-1). 137 microg x L-(-1)), and villus height (jejunum 620 microm +/- 56 microm, ileum 450 microm +/- 31 microm) and mucosal thickness (jejunum 800 microm +/- 52 microm, ileum 633 microm +/- 33 microm) than those in ENcon, EN+Gln (jejunum villus height and mucosa thickness 450 microm +/- 47 microm and 610 +/- 63 microm, ileum villus height and mucosa thickness 330 microm +/- 39 microm and 500 microm +/- 52 microm), EN+GH groups (P【0.05), and than those in EN+Fib group although no statistical significance was attained. CONCLUSION: Both dietary fiber and GH when used separately can enhance the postresectional small bowel structural adaptation. Simultaneous use of these two gut-trophic factors can produce synergistic effects on small bowel structural adaptation. Enteral glutamine perfusion is beneficial in preserving small bowel mucosal structure during TPN, but has little beneficial effect during EN.

膳食纤维基靶向结肠递送短链脂肪酸体系缓解炎症性肠病的研究进展

低膳食纤维饮食可通过改变肠道菌群组成、短链脂肪酸水平、肠道屏障完整性和免疫系统稳态等途径参与炎症性肠病的发生与发展。以膳食纤维为载体,靶向递送短链脂肪酸至结肠部位以改善肠道内环境稳态可有效缓解炎症性肠病。该文在阐述低膳食纤维饮食与炎症性肠病关系的基础上,对膳食纤维靶向结肠递送短链脂肪酸改善炎症性肠病的作用机制、形式以及常见载体进行综述,并展望膳食纤维递送体系未来发展方向。

基于残差神经网络、双向长短期记忆网络和注意力机制的肠鸣音检测方法研究

肠鸣音可以反映胃肠道的运动和健康状况,然而,传统的人工听诊方式存在主观性偏差且耗时耗力。为了更好地辅助医生对肠鸣音的诊断,提高肠鸣音检测的可靠性和高效性,该研究提出了一种结合残差神经网络(ResNet)、双向长短期记忆网络(BiLSTM)和注意力机制的深度神经网络模型。首先使用自主研发的多通道肠鸣音采集系统采集了大量带标签的临床数据,采用多尺度小波分解和重构方法对肠鸣音信号进行预处理,然后提取对数梅尔谱图特征送入网络进行训练,最后通过10折交叉验证和消融实验来评估模型的性能和验证其有效性。实验结果表明,该模型在精确率、召回率和F1分数方面分别达到了83%、76%和79%,能够有效地检测出肠鸣音片段并定位其起止时间,表现优于以往的算法。该算法不仅可以为医生在临床实践中提供辅助信息,还为肠鸣音的进一步分析和研究提供了技术支撑。

预后营养指数与结直肠癌伴急性肠穿孔一期切除并吻合后预后的相关性研究

目的探讨预后营养指数(predictive nutritional index,PNI)能否通过术前营养和炎症状态预测结直肠癌伴急性肠穿孔病人的术后并发症及5年总生存率和无复发生存率。方法回顾性分析2012年12月至2018年6月在北京朝阳医院普通外科住院的结直肠癌伴急性肠穿孔病例,其中接受根治性结直肠切除术并一期吻合者57例。统计病人的临床病理资料、术前PNI、术后并发症、术后生存及复发情况等;采用受试者操作特征曲线计算出病人的术前PNI截断值;采用logistic回归分析病人的PNI与术后并发症的相关性;采用Kaplan-Meier曲线分析病人的5年总生存期和无复发生存期。结果结直肠癌伴急性肠穿孔病人的术前PNI截断值为32。低PNI组相对于高PNI组病人的年龄更大(P=0.0285)、ASAⅢ~Ⅳ级者更多(P=0.0147)、T_(4)分期者更多(P=0.0281),而且术后吻合口漏发生率更高(P=0.0314)、30 d死亡率更高(P=0.0303)以及住院时间更长(P=0.0242)。多因素分析表明低PNI是结直肠癌伴急性肠穿孔病人发生吻合口漏(OR=1.63,95%CI:1.56–3.82,P=0.0308)的危险因素,但是PNI与病人的5年总生存率和无复发生存率没有相关性。结论术前PNI<32与结直肠癌伴急性肠穿孔病人根治性切除并一期吻合术后的吻合口漏发生率增加、30 d死亡率升高以及住院时间延长有关。

痛泻安肠方对肠易激综合征小鼠短链脂肪酸代谢及Th1/Th2细胞免疫平衡的影响

目的观察痛泻安肠方对肝郁脾虚证腹泻型肠易激综合征(IBS-D)小鼠模型短链脂肪酸代谢及Th1/Th2细胞免疫平衡的影响。方法30只18~22 g的雄性C57BL/6小鼠随机分为空白组、模型组、痛泻安肠方低剂量组、痛泻安肠方中剂量组、痛泻安肠方高剂量组,每组6只。采用束缚应激联合番泻叶灌胃复制IBS-D小鼠模型,造模成功后分别予相应浓度中药灌胃14 d,每日1次,通过靶向代谢组学检测小鼠粪便中短链脂肪酸含量的变化,并通过流式细胞术检测肠系膜淋巴结中CD3+CD4+INF-γ+T细胞(Th1细胞)、CD3+CD4+IL-4+T细胞(Th2细胞)的占比情况。结果与空白组相比,模型组小鼠粪便短链脂肪酸(SCFAs)相对含量显著升高(P<0.01),尤其是乙酸、丙酸及丁酸的含量均显著升高(P<0.01或P<0.05);不同剂量痛泻安肠方治疗后,粪便总SCFAs相对含量显著降低(P<0.01),乙酸、丙酸及丁酸均有不同程度降低,其中痛泻安肠方各剂量组均可显著降低乙酸和丁酸的含量,差异具有统计学意义(P<0.01),低剂量组及中剂量组可显著降低丙酸的含量,差异具有统计学意义(P<0.01)。造模后,肠易激综合征小鼠肠系膜淋巴结的Th2细胞占比明显降低,而Th1细胞占比及Th1/Th2细胞比率明显升高,差异具有统计学意义(P<0.05);治疗后,痛泻安肠方各剂量组Th2细胞占比均有升高,Th1细胞占比及Th1/Th2细胞比率降低。结论痛泻安肠方可以降低IBS-D小鼠粪便SCFAs的含量,调节小鼠Th1/Th2细胞免疫紊乱。

Growth hormone stimulates remnant small bowel epithelial cell proliferation

INTRODUCTIONCurrently the major treatment choices for shortbowel syndrome are parenteral nutrition and smallbowel transplantation.Both therapies involvegreat fiscal challenge and recurring complications.Recent years have witnessed the promisingexperimental results of pharmacologicalrehabilitation of remnant small bowel.

Estimation of quality of life in Cypriot patients with inflammatory bowel disease

AIMTo investigate the health-related quality of life (HRQoL) of patients suffering with idiopathic inflammatory bowel disease (IBD).METHODSThe Greek validated version of the Short Inflammatory Bowel Disease Questionnaire was used for evaluating the quality of life of IBD patients. The questionnaire was distributed to 100 consecutive patients suffering from IBD and presenting for a clinic appointment at the endoscopy unit of Larnaca General Hospital during the period from October to November 2012. The criteria for participating in this study were constituted by the documented diagnosis of either ulcerative colitis (UC) or Crohn&#x02019;s disease (CD) after endoscopy and histologic examination at least 6 months before the study, adult patients (18 years old or older), the capability of verbal communication and the patient&#x02019;s written consent for attending this study. The majority of the questionnaires were completed by a nurse practitioner who specializes in IBD patient care.RESULTSRegarding the physical dimension in patients with UC, males scored significantly higher than females (4.2 vs 3.4, P = 0.023). Higher scores were also observed in UC patients younger than 35 or older than 50 years (4.0 and 4.2 vs 3.2, respectively, P = 0.021). The psychological dimension revealed similar results in patients with UC, with males, and older ages scoring higher (5.0 vs 3.0, P = 0.01 and 4.7 vs 2.7, P &#x0003c; 0.5, respectively), whereas regarding CD higher scores were observed in married compared to unmarried (3.83 vs 2.33, P = 0.042). No statistical differences in any parameters in the social dimension were observed. Regarding the treatment of, patients with CD, overall higher scores were observed when treated with biological factors compared to standard therapy in all dimensions but with statistical significant difference in the social dimension (5.00 vs 3.25, P = 0.045).CONCLUSIONThe study reveals a negative impact of IBD on HRQoL. Increased risks are age and gender in patients with UC and family status in patients with CD.