P0478 QUALITY OF LIFE IN CHILDHOOD CONSTIPATION: A CASE CONTROL STUDY

Abstract

Introduction: The aim of this study was to determine the effect of chronic constipation on quality of life (QoL) in children and adolescents. Methods: From 10/ 2002 to 11/ 2003, 224 children, (140 male, aged 10.6 +/− 2.9 yrs) and 224 parents were administered a health related QoL tool (PedsQL) in pediatric gastroenterology and general pediatric practices at time of initial evaluation. The PedsQL consists of 4 measures (physical, emotional, social, school) and are scored on a 0 (poor) to100 (best) scale. Children and their families with constipation (CONS, n=80) were compared to control patients: inflammatory bowel disease (IBD, n=42), gastroesophageal reflux disease (GERD, n=56), and healthy children (HC, n=46). Children with constipation had associated abdominal pain (89%) and fecal soiling (29%). Scores were also compared between children and parents to assess differences in perception. Results: CONS children had overall lower quality of life self-reported scores compared to controls: IBD (70 vs. 84, p<0.05); GERD (70 vs. 80, p <0.05); HC (70 vs. 88, p<0.05). There was no difference in QoL between CONS children with or without fecal soiling (70 vs. 74, p=ns). CONS children reported lower physical scores: IBD (75 vs. 85, p<0.02); GERD (75 vs. 85, p<0.05); HC (75 vs. 87, p<0.05). Parents of CONS children reported overall lower quality of life scores compared to their own children’s self reported scores: (61 vs. 70, p<0.05). CONS children presented with longer duration of symptoms versus controls (43.8 months vs. 14.2 months, p<0.001). Duration of symptoms for CONS was associated with lower parent reported scores (p<0.002). Families of CONS children reported a positive family history of constipation and/or irritable bowel syndrome more than controls (40.2% vs. 8.9%, p<0.05). Conclusion: At time of initial evaluation, children with chronic constipation have a lower QoL as compared to those who have IBD and GERD. Self-reported lower QoL scores maybe a reflection of associated abdominal pain and painful defecation leading to impaired physical ability. Parents perceptions of low QoL in their children likely represent concerns with duration of symptoms and family members that have similar complaints. Increased recognition by practioners on the lowered QoL and high level of parental concern in pediatric chronic constipation may lead to more prompt and aggressive management as is seen in children with IBD and GERD. Disease specific health related QOL tools need to be created for better evaluation and assessment of therapeutic intervention.