Abdominal symptoms in relation to perceived health in adults with Familial Adenomatous Polyposis (FAP)

Transcription

1 Abdominal symptoms in relation to perceived health in adults with Familial Adenomatous Polyposis (FAP) Kaisa Fritzell, RN, MSc, Phd student Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute, Sweden The Swedish Polyposis Registry, Karolinska University Hospital, Stockholm 1

2 FAP bowel function increased bowel frequency day and night incontinence day and night faecal urgency day and night perianal soreness dietary restrictions 2

3 Sample All patients included in the national Swedish polyposis registry, Karolinska University Hospital, diagnosed with FAP, age 18-75, who had undergone prophylactic colorectal surgery, (n=275) 3

4 Demographics, (n=209) n % Age, mean (range) 49 (18-75) Sex Men Women Living situation Living with partner Other 9 4 Single Participants having children

5 Clinical characteristics, (n=209) n % Mean age at colorectal surgery, y (range) 28 (5-58) Mean time since colorectal surgery, y (range) 21 (1-50) Colorectal surgery at time for study IPAA IRA Ileostomy Other 17 8 Numbers of colorectal surgery One Two Three or more

6 Disturbing abdominal symptoms (n=209) n % Diarrhea 67 Borborygmus 62 Night time urge of defecation 60 Abdominal distension 50 Abdominal discomfort or pain relieved by defecation 42 Interfering flatus 34 Feelings of incomplete defecation 33 Uncomfortable feeling of fullness after meals 33 Nausea 32 Retrosternal pain 32 Belching 31 Heartburn 29 Early satiety 28 Abdominal discomfort or pain at defecation 28 Reflux episodes 23 Loss of appetite 19 Constipation 13 Altering diarrhea and constipation 10 Vomiting 9 Loss of weight 8 Dysphagia 6 6

7 Disturbing abdominal symptoms (n=209) n % Diarrhea 67 Borborygmus 62 Night time urge of defecation 60 Abdominal distension 50 Abdominal discomfort or pain relieved by defecation 42 Interfering flatus 34 Feelings of incomplete defecation 33 Uncomfortable feeling of fullness after meals 33 Nausea 32 Retrosternal pain 32 Belching 31 Heartburn 29 Early satiety 28 Abdominal discomfort or pain at defecation 28 Reflux episodes 23 Loss of appetite 19 Constipation 13 Altering diarrhea and constipation 10 Vomiting 9 Loss of weight 8 Dysphagia 6 7

8 Disturbing abdominal symptoms (n=209) n % Diarrhea 67 Borborygmus 62 Night time urge of defecation 60 Abdominal distension 50 Abdominal discomfort or pain relieved by defecation 42 Interfering flatus 34 Feelings of incomplete defecation 33 Uncomfortable feeling of fullness after meals 33 Nausea 32 Retrosternal pain 32 Belching 31 Heartburn 29 Early satiety 28 Abdominal discomfort or pain at defecation 28 Reflux episodes 23 Loss of appetite 19 Constipation 13 Altering diarrhea and constipation 10 Vomiting 9 Loss of weight 8 Dysphagia 6 8

9 Disturbing abdominal symptoms (n=209) % Diarrhea 67 Borborygmus 62 Night time urge of defecation 60 Abdominal distension 50 Abdominal discomfort or pain relieved by defecation 42 Interfering flatus 34 Feelings of incomplete defecation 33 Uncomfortable feeling of fullness after meals 33 Nausea 32 Retrosternal pain 32 Belching 31 Heartburn 29 Early satiety 28 Abdominal discomfort or pain at defecation 28 Reflux episodes 23 Loss of appetite 19 Constipation 13 Altering diarrhea and constipation 10 Vomiting 9 Loss of weight 8 Dysphagia 6 9

10 Number of symptoms (21 items) Mean SD Range Males Females p < IRA IPAA ns Ileostomy Tested for differences by t-test and ANOVA, significance level P <

11 Physical Health Hierarchical multiple linear regression analyses with PCS a as the dependent variable (participants=183) Step1 Step 2 PCS a R 2 Change R 2 Adj F 0.131* * Step * 0.217* * *p<0.01 The scores for PCS range from 0 to 100 with higher scores indicating better health status. Step 1: age, gender, FAP in the family Step 2: time since last colorectal surgery Step 3: number of abdominal symptoms, troublesomeness 11

12 Mental Health Hierarchical multiple linear regression analyses with MCS a as the dependent variable (participants=183) Step 1 MCS a R 2 Change R 2 Adj F Step 2 Step * * * 0.226* * *p<0.01 The scores for MCS range from 0 to 100 with higher scores indicating better health status. Step 1: age, gender, FAP in the family Step 2: time since last colorectal surgery Step 3: number of abdominal symptoms, troublesomeness 12

13 Conclusion Surgically treated patients with FAP suffers from a wide range of abdominal symptoms No differences in number of symptoms were reported by type of prophylactic colorectal surgery Women reported more symptoms than men The strongest predictor of patients physical and mental health was number of self-reported abdominal symptoms 13

14 Clinical implikations Identify those patients suffering from a high number of abdominal symptoms Base symptom management on patients perception of abdominal symptoms Use pharmacological treatment and offer advice regarding dietary restrictions 14

15 Lena Wettergren, RN, PhD, Assistant senior lecturer, Department of Neurobiology, Care Sciences and Society, Division of Nursing, KI Jan Björk, MD, PhD, Department of Medicine, KI. The Swedish Polyposis Registry Lars E Eriksson, RN, PhD, Associate professor, Department of Neurobiology, Care Sciences and Society, Division of Nursing, KI Rolf Hultcrantz, MD, PhD, Professor, Department of Medicine, KI, The Swedish Polyposis Registry 15

16 Thank you 16