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

Marco Crocco ¹, Federica Malerba ², Angela Calvi ³, Noemi Zampatti ², Francesco Valitutti ⁴, Livia Pisciotta ⁵, Consuelo Borgarelli ⁵, Monica Montuori ⁶, Salvatore Oliva ⁶, Giulia Catassi ⁶, Raffaele Borghini ⁶, Chiara Maria Trovato ⁷, Francesca Ferretti ⁷, Enrico Felici ⁸, Barbara Roviglione ⁸, Alice Monzani ⁹, Chiara Terzi ¹⁰, Federico Caldonazzi ¹¹, Valentina Bortolotti ¹¹, Elena Cavalli ⁴, Rita Cozzali ⁴, Maria Teresa Illiceto ¹², Michele Citrano ¹³, Francesco Graziano ¹³, Claudio Romano ¹⁴, Francesca Laganà ¹⁴, Renata Auricchio ¹⁵, Jacopo Ferro ¹⁶, Paolo Gandullia ³, Stefania Proietti ¹⁷, Stefano Bonassi ¹⁸

Author information

¹Pediatric Gastroenterology and Endoscopy Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy. Electronic address: marcocrocco@gaslini.org.

²Pediatric 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.

³Pediatric Gastroenterology and Endoscopy Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy.

⁴Pediatric Clinic, Department of Surgical and Biomedical Sciences, University of Perugia, 06129 Perugia, Italy.

⁵Department of Internal Medicine, University of Genova, 16132 Genoa, Italy; IRCCS Polyclinic Hospital San Martino, 16132 Genoa, Italy.

⁶Department of Women's and Children's Health Pediatric Gastroenterology and Liver Unit Umberto I Hospital Sapienza University of Rome, 00161 Rome, Italy.

⁷Gastroenterology and Nutritional Rehabilitation Unit, IRCCS Bambino Gesù Children's Hospital, 00165 Rome, Italy.

⁸Pediatric and Pediatric Emergency Unit, Children Hospital, AO SS Antonio e Biagio e C. Arrigo, 15121 Alessandria, Italy.

⁹Division of Pediatrics, Department of Health Sciences, Università del Piemonte Orientale, 28100 Novara, Italy.

¹⁰Pediatria ospedale Bolognini, Asst bergamoest, 24068 Seriate (BG), Italy.

¹¹Pediatric Department APSS, Pediatric Unit, 38123 Rovereto (TN), Italy.

¹²Gastroenterologia ed Endoscopia Digestiva Pediatrica, UOC Pediatria, O.C. Spirito Santo, 65124 Pescara, Italy.

¹³Pediatric Unit, Villa Sofia Cervello Hospital, 90146 Palermo, Italy.

¹⁴Unit of Pediatric Gastroenterology and Cystic Fibrosis, Department of Human Pathology in Adulthood and Childhood 'G. Barresi', University of Messina, 98122 Messina, Italy.

¹⁵Department of Translational Medical Science, University Federico II, 80131 Naples, Italy; European Laboratory for Food Induced Diseases, University Federico II, 80131 Naples, Italy.

¹⁶Pathology Unit, U.O.C. Anatomia Patologica, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy.

¹⁷Unit of Clinical and Molecular Epidemiology, IRCCS San Raffaele Pisana, 00166 Rome, Italy.

¹⁸Unit 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.

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.