NEW real-world data from a multicentre Palestinian cohort highlight that the drivers of health-related quality of life (HRQoL) differ substantially between Crohn’s disease and ulcerative colitis, with phenotype-specific patterns linked to inflammation, structural disease, treatment burden, and modifiable risk factors.
In this cross-sectional study, researchers evaluated 301 adults with inflammatory bowel disease treated across eight governmental hospitals in the Palestinian West Bank between December 2018 and June 2024. Of the cohort, 219 patients had Crohn’s disease and 82 had ulcerative colitis. Health-related quality of life was assessed using the Short Inflammatory Bowel Disease Questionnaire (SIBDQ), with multivariable analyses performed separately for each phenotype to identify determinants of both total and domain-level HRQoL.
Distinct Clinical Profiles
Patients with ulcerative colitis were older and less likely to be male compared with those with Crohn’s disease. In contrast, Crohn’s disease was characterised by greater structural involvement, with higher rates of intestinal stenosis and prior surgery. Markers of active inflammation also differed between phenotypes, with very high baseline faecal calprotectin levels more commonly observed in ulcerative colitis.
Crohn’s Disease: Inflammation and Structure Drive HRQoL
In Crohn’s disease, impaired HRQoL was primarily driven by ongoing inflammatory activity and structural disease. Higher faecal calprotectin levels at 3 months and imaging evidence of active disease, including a positive comb sign, were independently associated with lower total SIBDQ scores. By contrast, achieving clinical remission had a strong protective effect on overall quality of life.
Domain-level analyses revealed further nuance. Bowel-related quality of life was worse among patients receiving infliximab, while systemic symptoms were linked to persistent inflammatory activity. Emotional wellbeing was particularly affected by smoking and elevated inflammatory markers, highlighting the impact of both biological and behavioural factors.
Ulcerative Colitis: Treatment Burden and Comorbidity
In ulcerative colitis, reduced HRQoL was more closely associated with structural involvement and cumulative treatment exposure. Lower total SIBDQ scores were independently linked to imaging markers of disease severity and longer therapy duration, suggesting that treatment burden plays a key role in shaping patient experience.
At the domain level, social functioning was negatively affected by comorbid hypertension, while emotional wellbeing was strongly associated with smoking and ongoing inflammation. These findings emphasise the broader systemic and psychosocial influences on quality of life in ulcerative colitis.
Clinical Implications
The authors conclude that correlates of HRQoL differ meaningfully between Crohn’s disease and ulcerative colitis, underscoring the need for phenotype-specific, patient-centred management strategies. Although causality cannot be inferred from this cross-sectional analysis, the results support integrating objective inflammatory markers and imaging findings into HRQoL-guided, treat-to-target approaches in routine care. Longitudinal studies are now needed to validate these associations over time and inform interventions aimed at improving quality of life across inflammatory bowel disease phenotypes.
Reference
Alkrinawi J et al. Phenotype-specific determinants of health-related quality of life in Crohn’s disease and ulcerative colitis: a multicenter cross-sectional study. BMC Gastroenterol. 2026;DOI: 10.1186/s12876-025-04584-6.
