Brief Article
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World J Gastroenterol. Jan 28, 2013; 19(4): 542-549
Published online Jan 28, 2013. doi: 10.3748/wjg.v19.i4.542
Relationship between diversion colitis and quality of life in rectal cancer
Dong Nyoung Son, Dong Jin Choi, Si Uk Woo, Jin Kim, Bo Ra Keom, Chul Hwan Kim, Se Jin Baek, Seon Hahn Kim
Dong Nyoung Son, Jin Kim, Se Jin Baek, Seon Hahn Kim, Colorectal Division, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul 136-705, South Korea
Dong Jin Choi, Department of Surgery, Sun General Hospital, Daejeon 301-747, South Korea
Si Uk Woo, Department of Surgery, Gangseo Song-do Hospital, Seoul 139-711, South Korea
Bo Ra Keom, Department of Gastroenterology, Korea University Anam Hospital, Korea University College of Medicine, Seoul 136-705, South Korea
Chul Hwan Kim, Department of Pathology, Korea University Anam Hospital, Korea University College of Medicine, Seoul 136-705, South Korea
Author contributions: Son DN, Choi DJ, Kim J and Kim SH designed the research; Son DN, Choi DJ, Woo SU and Kim J collected the data; Son DN, Baek SJ, Geom BR, Kim CH and Kim SH analyzed and interpreted the data; Son DN wrote the manuscript; Kim SH critically reviewed the manuscript.
Supported by The 2007 SK Chemical Grant of the Korean Society of Gastroenterology
Correspondence to: Seon Hahn Kim, MD, Colorectal Division, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, 126-1, 5 Ga, Anam-Dong, Seongbuk-Gu, Seoul 136-705, South Korea. drkimsh@korea.ac.kr
Telephone: +82-2-9206644 Fax: +82-2-9281631
Received: September 3, 2012
Revised: November 7, 2012
Accepted: December 15, 2012
Published online: January 28, 2013
Processing time: 148 Days and 6.7 Hours
Abstract

AIM: To investigated the incidence of diversion colitis (DC) and impact of DC symptoms on quality of life (QoL) after ileostomy reversal in rectal cancer.

METHODS: We performed a prospective study with 30 patients who underwent low anterior resection and the creation of a temporary ileostomy for the rectal cancer between January 2008 and July 2009 at the Department of Surgery, Korea University Anam Hospital. The participants totally underwent two rounds of the examinations. At first examination, endoscopies, tissue biopsies, and questionnaire survey about the symptom were performed 3-4 mo after the ileostomy creations. At second examination, endoscopies, tissue biopsies, and questionnaire survey about the symptom and QoL were performed 5-6 mo after the ileostomy reversals. Clinicopathological data were based on the histopathological reports and clinical records of the patients.

RESULTS: At the first examination, all of the patients presented with inflammation, which was mild in 15 (50%) patients, moderate in 11 (36.7%) and severe in 4 (13.3%) by endoscopy and mild in 14 (46.7%) and moderate in 16 (53.3%) by histology. At the second examination, only 11 (36.7%) and 17 (56.7%) patients had mild inflammation by endoscopy and histology, respectively. There was no significant difference in DC grade between the endoscopic and the histological findings at first or second examination. The symptoms detected on the first and second questionnaires were mucous discharge in 12 (40%) and 5 (17%) patients, bloody discharge in 5 (17%) and 3 (10%) patients, abdominal pain in 4 (13%) and 2 (7%) patients and tenesmus in 9 (30%) and 5 (17%) patients, respectively. We found no correlation between the endoscopic or histological findings and the symptoms such as mucous discharge, bleeding, abdominal pain and tenesmus in both time points. Diarrhea was detected in 9 patients at the second examination; this number correlated with the severity of DC (0%, 0%, 66.7%, 33.3% vs 0%, 71.4%, 23.8%, 4.8%, P = 0.001) and the symptom-related QoL (r = -0.791, P < 0.001).

CONCLUSION: The severity of DC is related to diarrhea after an ileostomy reversal and may adversely affect QoL.

Keywords: Diversion colitis; Quality of life; Diarrhea; Ileostomy; Rectal cancer