107 Extraintestinal Manifestations and Their Impact on Quality of Life and Health Perception in Patients With Ulcerative Colitis After Ileal Pouch-Anal Anastomosis

Background: Extraintestinal manifestations (EIMs) are a significant yet often overlooked component of inflammatory bowel diseases (IBD). EIMs refer to inflammatory or immune-mediated conditions occurring outside the gastrointestinal tract that can potentially impact overall disease burden, even when intestinal symptoms are well controlled. In patients who undergo ileal pouch-anal anastomosis (IPAA) after colectomy for ulcerative colitis (UC), EIMs may persist or arise de novo, posing an impact to quality of life (QoL). In this study, we evaluate the prevalence of EIMs and assess QoL using a validated questionnaire in patients post-IPAA. Methods: This study includes patients with UC who underwent IPAA at a tertiary care center. Medical data and information pertaining to EIMs was acquired through record review. QoL was assessed using a single administration of the validated Cleveland Global Quality of Life questionnaire (termed Fazio Score), which evaluates 3 domains: overall QoL, perceived quality of health (QoH), and energy levels, each rated on a scale from 0 (worst) to 10 (best). Bivariate analyses were executed. This study is IRB-approved. Results: A total of 48 patients with UC post-IPAA were evaluated for EIMs and QoL (29F/19M, mean age 40.5 ± 13.2). The most frequently reported EIMs were non-specific arthritis (50.0%), undifferentiated anemia (37.5%), arthralgias (31.3%), osteopenia (22.9%), nephrolithiasis (16.7%), oral lesions (14.6%), osteoporosis (12.5%), erythema nodosum (6.3%), thromboembolic events (6.3%), sacroiliitis (4.2%), and primary sclerosing cholangitis (2.1%). Interestingly, 60.4% experience 2 or more EIMs. No patients indicated ankylosing spondylitis nor pyoderma gangrenosum. When evaluating QoL, 4.2% scored from 1–4, 29.2% between 5–7, and 66.7% from 8–10. QoH ratings were 4.2% in the 1–4 range, 27.1% in 5–7, and 68.7% in 8–10. Energy levels were reported as 12.5% from 1–4, 35.4% between 5–7, and 52.1% from 8–10. There was statistical significance between those with an EIM and expressing a lesser QoH compared to patients without EIMs, mostly rating QoH from 1–4 or 5–7 (P = 0.002). Nonetheless, there was no statistical difference between patients with and without EIMs when rating QoL and energy levels (P > 0.05). No statistical significance was found when comparing ratings of QoL, QoH, and energy levels between those who experienced 2 or more EIMs rather than none or just one (all P > 0.05). Conclusions: In this cohort post-IPAA, EIMs did not appear to significantly influence overall QoL or energy levels. Patients with and without EIMs reported similar distribution across these domains, suggesting that the impact of EIMs may be less pronounced than expected. Nonetheless, QoH ratings were lower in patients with at least 1 EIM compared to those without EIMs, likely reflecting the burden of chronic symptomatology and additional medical interventions associated with EIMs. These findings argue for targeted approaches to EIMs within patients post-IPAA, with the aim of improving health perception in this population.