Quality of Life in Paediatric Crohn’s Disease: Data From the Imagekids Study

Background: The evaluation of health-related quality of life (HRQOL), using the validated disease-specific IMPACT-III questionnaire, has a key role in ascertaining the effect of disease on patients with Crohn’s disease (CD). We sought to describe HRQOL variations across a large prospective cohort of paediatric CD patients with varying disease experience. Methods: We used the prospectively collected data from the ImageKids study (a multicentre, multinational study designed to develop the pMEDIC and PICMI scores for magnetic resonance enterography) on children diagnosed with CD. IMPACT-III (35-item self-administered scale) was used to assess HRQOL in this cohort. Results: Data from 180 patients were analysed, 94 males (52.2%) with a mean age of 14.2±2.2y and a median of 27 month (IQR 0.05–4.2)of follow-up. According to wPCDAI, 29.0% of patients were in clinical remission, whereas 39%, 13%, and 19% had mild, moderate, and severe disease, respectively. IMPACT-III total score had a poor but significant correlation with degree of mucosal inflammation judged by the SES-CD (r = -0.285, p \u3c 0.0001). Correlation was strong with clinical activity judged by wPCDAI (r = -0.550, p \u3c 0.0001). Patients with higher disease activity had lower total IMPACT-III score, as did the 4 domains (wellbeing, emotional functioning, social functioning, and body image, Table I). Differences across wPCDAI groups were higher for wellbeing and lower for body-image domains (Figure 1). Patients with perianal disease had lower wellbeing (p = 0.026) and body image (p = 0.004) domain scores. Steroid treatment was associated more with lower emotional functioning score than enteral nutrition was (p = 0.028). Conclusions: In this ImageKids cohort, HRQOL was lower in patients with higher disease activity and in those with perianal disease. An awareness of which domains within IMPACT may be differentially affected by various therapies or disease characteristics could help the clinician by focusing interventions (ie, psychological) to address these areas of concern