Evaluación de la Calidad de vida en pacientes con enfermedadinflamatoria intestinal: Un análisis muticéntrico en Latinoamerica

K. Villa Ovalles; J. Pérez Baldioceda; L. Ortega Giordanelli; P. Núñez Figueroa; NM. García Cárdenas; R. Franco Vásquez; OM. Díaz Espaillat; C. Azañedo Barrantes; N. Aguilar Estay; AH. Yapor Colón; A. Sánchez Orozco

Authors

K. Villa Ovalles Centro de Gastroenterología Dr. Luis Eduardo Aybar
J. Pérez Baldioceda Central Hospital of San Cristóbal, Venezuela
L. Ortega Giordanelli San Borja Arriarán Hospital, Chile
P. Núñez Figueroa Roosevelt Hospital, Guatemala
NM. García Cárdenas María Auxiliadora Hospital, Peru
R. Franco Vásquez San Pablo Clinic, Peru
OM. Díaz Espaillat Hospital Metropolitano de Santiago (HOMS), Dominican Repúblic
C. Azañedo Barrantes San Juan de Dios Hospital, Chile
N. Aguilar Estay Postgraduate Resident in Gastroenterology, Hospital Vargas de Caracas, Venezuela
AH. Yapor Colón Hospital General Docente de la Policía Nacional, Santo Domingo, Dominican Republic
A. Sánchez Orozco Dr. José Gregorio Hernández Pediatric Medical Center, Venezuela

Keywords:

Inflammatory bowel disease, ulcerative colitis, Crohn’s disease, quality of life, IBDQ-32, clinical activity

Abstract

Inflammatory Bowel Disease (IBD) significantly affects health-related quality of life (HRQoL), particularly in regions with unequal access to advanced therapies, such as Latin America. Although traditional clinical indices allow assessment of inflammatory activity, they fail to capture the patient’s subjective experience and the emotional, functional, and social burden of the disease. Objective: To identify factors associated with HRQoL in patients with IBD across five Latin American countries, to assess its relationship with clinical severity, and to describe differences according to disease type. Methods: Multicenter, cross-sectional study conducted between July 2023 and September 2024. HRQoL was measured using the IBDQ-32 questionnaire, and clinical activity was evaluated using the Harvey-Bradshaw Index for Crohn’s disease (CD) and the Modified Mayo Score for ulcerative colitis (UC). Associations with clinical, demographic, and psychosocial variables were analyzed. Results: A total of 149 patients were included. UC was the predominant condition (72.48%). Patients with CD had higher rates of clinical remission (58.54%) and better HRQoL scores, whereas UC was associated with greater inflammatory activity and higher emotional burden. Clinical severity, female sex, and disease type were significantly associated with HRQoL. Conclusions: HRQoL in IBD is influenced by factors beyond clinical activity alone. Emotional impact, functional limitations, uncertainty regarding disease flares, and regional variability in access to treatment contribute substantially to overall patient well-being. Incorporating patient-reported outcomes (PROs) should be considered an essential component of IBD management in Latin America.

References

1. Ng SC, Shi HY, Hamidi N, Underwood FE, Tang W, Benchimol EI, et al. Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies. Lancet. 2017 Dec 23;390(10114):2769–78.

2. Torres J, Mehandru S, Colombel JF, Peyrin-Biroulet L. Crohn’s disease. Lancet. 2017;389(10080):1741–55.

3. Ungaro R, Mehandru S, Allen PB, Peyrin-Biroulet L, Colombel JF. Ulcerative colitis. Lancet. 2017;389(10080):1756–70.

4. Vavricka SR, Rogler G, Pittet V, Michetti P, Felley C. Extraintestinal manifestations of inflammatory bowel disease. Inflamm Bowel Dis. 2015;21(8):1982–92.

5. Molodecky NA, Soon IS, Rabi DM, Ghali WA, Ferris M, Chernoff G, et al. Increasing incidence and prevalence of the inflammatory bowel diseases with time: a systematic review. Gastroenterology. 2012;142(1):46–54.e42.

6. Kaplan GG, Windsor JW. The four epidemiological stages in the global evolution of inflammatory bowel disease. Nat Rev Gastroenterol Hepatol. 2021;18(1):56–66.

7. Ananthakrishnan AN. Environmental risk factors for inflammatory bowel diseases: a review. Dig Dis Sci. 2015 Feb;60(2):290–8.

8. Pérez-Cuadrado Robles E, et al. Epidemiology of inflammatory bowel disease in Latin America: a systematic review. World J Gastroenterol. 2020;26(25):3678–94.

9. Cosnes J, Gower-Rousseau C, Seksik P, Cortot A. Epidemiology and natural history of inflammatory bowel diseases. Gastroenterology. 2011;140(6):1785–94.

10. Peyrin-Biroulet L, Germain A, Patel AS, Lindsay JO. Systematic review: outcomes and quality of life in inflammatory bowel disease. Clin Gastroenterol Hepatol. 2017;15(4):473–81.

11. Irvine EJ. Quality of life of patients with ulcerative colitis: past, present, and future. Inflamm Bowel Dis. 2008;14(4):554–65.

12. Hogberg C, Karling P, Rutegård J, Lilja M. Diagnosed anxiety and depression in patients with inflammatory bowel disease. Scand J Gastroenterol. 2017;52(1):28–34.

13. World Health Organization. WHOQOL: Measuring Quality of Life. Geneva: WHO; 1997.

14. Guyatt GH, Feeny DH, Patrick DL. Measuring health-related quality of life. Ann Intern Med. 1993;118(8):622–9.

15. Van Langenberg DR, Gibson PR. Systematic review: fatigue in inflammatory bowel disease. Aliment Pharmacol Ther. 2010;32(2):131–43.

16. Graff LA, Walker JR, Bernstein CN. Depression and anxiety in inflammatory bowel disease. Inflamm Bowel Dis. 2009;15(7):1106–14.

17. Irvine EJ, Zhou Q, Thompson AK. The Short Inflammatory Bowel Disease Questionnaire: a quality of life instrument for community physicians. Inflamm. 1996;2(2):101–8.

18. Ghosh S, Louis E, Beaugerie L, Bossuyt P, Bouguen G, Bourreille A, et al. Development of the IBD Disk: a visual self-administered tool for assessment of disability in inflammatory bowel disease. J Crohns Colitis. 2017;11(3):369–77.

19. Casellas F, López-Vivancos J, Badia X, Vilaseca J, Malagelada JR. Impact of disease activity on health-related quality of life in patients with inflammatory bowel disease. Dig Dis Sci. 2001;46(4):712–20.

20. Knowles SR, Graff LA, Wilding H, Hewitt C, Keefer L, Mikocka-Walus A. Quality of life in inflammatory bowel disease: a systematic review and meta-analyses. Psychol Health. 2018;33(7):842–61.

21. Mikocka-Walus A, Pittet V, Rossel JB, von Känel R. Symptoms of depression and anxiety are independently associated with clinical recurrence of inflammatory bowel disease. Clin Gastroenterol Hepatol. 2016;14(6):829–35.

22. Sewitch MJ, Abrahamowicz M, Bitton A, Daly D, Wild GE, Cohen A. Psychological distress, social support, and disease activity in inflammatory bowel disease. Am J Gastroenterol. 2001;96(5):1470–9.

23. Bodger K, Allinson R. Costs of inflammatory bowel disease. Pharmacoeconomics. 2006;24(6):563–72.

24. Burisch J, Jess T, Martinato M, Lakatos PL; ECCO-EpiCom. The burden of inflammatory bowel disease in Europe. J Crohns Colitis. 2013;7(4):322–37.

25. European Federation of Crohn’s and Ulcerative Colitis Associations (EFCCA). The IMPACT Survey: Giving patients with IBD a voice. Brussels: EFCCA; 2014.

26. Yoshida EM, et al. Quality of life in Japanese patients with inflammatory bowel disease. J Gastroenterol. 2006;41(10):967–73.

27. Bastos JL, et al. Health-related quality of life in Brazilian patients with inflammatory bowel disease. Arq Gastroenterol. 2014;51(3):202–8.

28. Pérez R, et al. Calidad de vida en pacientes con enfermedad inflamatoria intestinal. Rev Gastroenterol Venez. 2016;70(2):65–72.

29. Casellas F, Barreiro-de Acosta M, Iglesias M, Robles V, Nos P, Mearin F. Factors affecting health-related quality of life of patients with inflammatory bowel disease. J Crohns Colitis. 2018;12(2):185–96.

30. Bernstein CN. The global burden of inflammatory bowel disease. Gastroenterology. 2015;149(5):1056–60.

31. Harbord M, Annese V, Vavricka SR, Allez M, Barreiro-de Acosta M, Boberg KM, et al. The first European evidence-based consensus on extra-intestinal manifestations in inflammatory bowel disease. J Crohns Colitis. 2016;10(3):239–54.

32. Rubin DT, Ananthakrishnan AN, Siegel CA, Sauer BG, Long MD. ACG clinical guideline: ulcerative colitis in adults. Am J Gastroenterol. 2019;114(3):384–413.