Evaluation of Quality of Life in Health by IMPACT-III in Colombian Pediatric Patients With Inflammatory Bowel Disease

Background: Inflammatory bowel disease (IBD) impacts various aspects of life affecting the physical, mental, familiar and social realms. Gastrointestinal symptoms and extraintestinal manifestations have a negative impact on quality of life (QoL), and lead to increased likelihood of stunted growth, delayed puberty, surgical interventions, frequent hospitalizations, and low self-esteem in pediatric patients. No studies evaluating QoL have been carried out in Colombia. The aim of this study is to determine the perception of QoL through the IMPACT-III questionnaire from a sample of patients from different reference centers. Methods: Cross-sectional study in pediatric patients with IBD followed in 5 institutions in different cities, between April 2022 and May 2023. Eligible subjects were identified, information collected included socio-demographic and clinical factors, and the IMPACT-III questionnaire was administered once. The score ranges between 35-175 points, with higher scores linked to better QoL. At the time of application of the questionnaire, clinical and demographic data were verified. Descriptive analysis was performed. Results: Response rate was 94.3%. The study included 33 pediatric patients, predominantly female (60.6%), with a mean age of 14.9 years (SD 3.4), ranging between 6 and 17.9 years, and predominantly in remission or with mild disease (94%). UC:CD ratio was 2:1. The mean time elapsed since diagnosis of the disease was 5.1 (range 1-15; SD 4.1) years. 75.8% of subjects had previous exposure to biological or small molecule therapy. Frequency of surgical history for IBD, presence of extraintestinal manifestations, and hospitalization requirement in the last year was 18.2%, 15.2%, and 6.1%, respectively. Participants from urban areas were 84.8%. High school students were 78.8%. The median IMPACT-III score was lower in subjects with CD compared to UC (126 with a range of 105-135 vs 147 with a range of 122-152). The domains most affected were related to systemic symptoms and emotional functioning, in UC with medians of 13 (interquartile range 12-14) and 27 (interquartile range 20-31); in CD with medians of 11 (interquartile range 9-11) and 23 (interquartile range 20-26), respectively. In the univariate analysis of clinical and socio-demographic variables in the different categories, characteristics with greater impact in QoL observed were male gender, shorter duration of the disease, history of perianal involvement, fistulizing or stenotic disease, history of surgery for IBD, hospitalization in the last 12 months for IBD and severe disease activity. No statistically significant differences were found in clinical or sociodemographic variables. Considering the sample size of the study, the methodological design and the absence of statistically significant associations in the univariate analysis, multivariate analysis was not performed. Conclusions: The results of this study show that better disease control and long-term maintenance of remission are important for achieving QoL in children with IBD. It is necessary to continue strengthening the support, and education of pediatric patients with IBD and their caregivers, with a comprehensive and multidisciplinary approach, which will result in improvement of QoL impacting activities of daily living and assimilation of the disease.