Predictive factors of health related quality of life in children and adolescents with celiac disease: An Italian multicenter study on behalf of the SIGENP

Marco Crocco; Federica Malerba; Angela Calvi; Noemi Zampatti; Francesco Valitutti; Livia Pisciotta; Consuelo Borgarelli; Monica Montuori; Salvatore Oliva; Giulia Catassi; Raffaele Borghini; Chiara Maria Trovato; Francesca Ferretti; Enrico Felici; Barbara Roviglione; Alice Monzani; Chiara Terzi; Federico Caldonazzi; Valentina Bortolotti; Elena Cavalli; Rita Cozzali; Maria Teresa Illiceto; Michele Citrano; Francesco Graziano; Claudio Romano; Francesca Laganà; Renata Auricchio; Jacopo Ferro; Paolo Gandullia; Stefania Proietti; Stefano Bonassi

doi:10.1016/j.dld.2024.12.020

Predictive factors of health related quality of life in children and adolescents with celiac disease: An Italian multicenter study on behalf of the SIGENP

Dig Liver Dis. 2025 Jan 11:S1590-8658(24)01145-9. doi: 10.1016/j.dld.2024.12.020. Online ahead of print.

Authors

Marco Crocco¹, Federica Malerba², Angela Calvi³, Noemi Zampatti², Francesco Valitutti⁴, Livia Pisciotta⁵, Consuelo Borgarelli⁵, Monica Montuori⁶, Salvatore Oliva⁶, Giulia Catassi⁶, Raffaele Borghini⁶, Chiara Maria Trovato⁷, Francesca Ferretti⁷, Enrico Felici⁸, Barbara Roviglione⁸, Alice Monzani⁹, Chiara Terzi¹⁰, Federico Caldonazzi¹¹, Valentina Bortolotti¹¹, Elena Cavalli⁴, Rita Cozzali⁴, Maria Teresa Illiceto¹², Michele Citrano¹³, Francesco Graziano¹³, Claudio Romano¹⁴, Francesca Laganà¹⁴, Renata Auricchio¹⁵, Jacopo Ferro¹⁶, Paolo Gandullia³, Stefania Proietti¹⁷, Stefano Bonassi¹⁸

Affiliations

¹ Pediatric Gastroenterology and Endoscopy Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy. Electronic address: [email protected].
² Pediatric Gastroenterology and Endoscopy Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, 16132 Genoa, Italy.
³ Pediatric Gastroenterology and Endoscopy Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy.
⁴ Pediatric Clinic, Department of Surgical and Biomedical Sciences, University of Perugia, 06129 Perugia, Italy.
⁵ Department of Internal Medicine, University of Genova, 16132 Genoa, Italy; IRCCS Polyclinic Hospital San Martino, 16132 Genoa, Italy.
⁶ Department of Women's and Children's Health Pediatric Gastroenterology and Liver Unit Umberto I Hospital Sapienza University of Rome, 00161 Rome, Italy.
⁷ Gastroenterology and Nutritional Rehabilitation Unit, IRCCS Bambino Gesù Children's Hospital, 00165 Rome, Italy.
⁸ Pediatric and Pediatric Emergency Unit, Children Hospital, AO SS Antonio e Biagio e C. Arrigo, 15121 Alessandria, Italy.
⁹ Division of Pediatrics, Department of Health Sciences, Università del Piemonte Orientale, 28100 Novara, Italy.
¹⁰ Pediatria ospedale Bolognini, Asst bergamoest, 24068 Seriate (BG), Italy.
¹¹ Pediatric Department APSS, Pediatric Unit, 38123 Rovereto (TN), Italy.
¹² Gastroenterologia ed Endoscopia Digestiva Pediatrica, UOC Pediatria, O.C. Spirito Santo, 65124 Pescara, Italy.
¹³ Pediatric Unit, Villa Sofia Cervello Hospital, 90146 Palermo, Italy.
¹⁴ Unit of Pediatric Gastroenterology and Cystic Fibrosis, Department of Human Pathology in Adulthood and Childhood 'G. Barresi', University of Messina, 98122 Messina, Italy.
¹⁵ Department of Translational Medical Science, University Federico II, 80131 Naples, Italy; European Laboratory for Food Induced Diseases, University Federico II, 80131 Naples, Italy.
¹⁶ Pathology Unit, U.O.C. Anatomia Patologica, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy.
¹⁷ Unit of Clinical and Molecular Epidemiology, IRCCS San Raffaele Pisana, 00166 Rome, Italy.
¹⁸ Unit of Clinical and Molecular Epidemiology, IRCCS San Raffaele Pisana, 00166 Rome, Italy; Department of Human Sciences and Quality of Life Promotion, San Raffaele University, 00166 Rome, Italy.

PMID: 39800588
DOI: 10.1016/j.dld.2024.12.020

Abstract

Background: In pediatric patients, celiac disease (CD) may influence the health-related quality of life (HRQoL).

Aims: The study aimed to assess HRQoL and further characterise the clinical factors associated with reduced HRQoL, in a large multicenter pediatric cohort with CD.

Methods: The disease-specific questionnaire CD Dutch Questionnaire (CDDUX) and the generic questionnaire Paediatric Quality of Life Inventory (PedsQL) were used to assess the HRQoL. Clinical and sociodemographic characteristics were analyzed, univariate and multivariate analysis were conducted.

Results: Eleven different Italian pediatric centers and 871 families were involved. Mean age at interview was 12.9 ± 2.9 years. The mean total CDDUX score of CD patients was 47.1 ± 18.8, revealing a neutral HRQoL (47.1 ± 18.8), and a good to very good HRQoL according to the PedsQL (81.4 ± 12.6), parents indicated lower scores (p = 0.03) with both questionnaires (CDDUX 45.1 ± 18.6 and PedsQL 79.9 ± 14.5). Patients with lower HRQoL were mainly female, living in Northern Italy, with lower parent's education level and non-biopsy diagnosis of CD. In multivariate analysis, the main predictor of lower CDDUX score was non-biopsy diagnosis.

Conclusions: The HRQoL in a large cohort of Italian children is reported as neutral-good. This indicates a high level of adaptive behaviors in response to the daily challenges of CD. Parents tend to underestimate their children's HRQoL. Specific clinical factors, including non-biopsy diagnosis, may be associated to lower HRQoL.

Keywords: Biopsy; Celiac disease; Disease specific questionnaire; Quality of life.