Fatigue in inflammatory bowel disease and its impact on daily activities

Abstract

SummaryBackgroundFatigue is a common symptom of chronic inflammation, including inflammatory bowel disease (IBD), resulting in significant impairment in quality of life.AimsTo identify the prevalence of fatigue in a large IBD cohort compared to the general population, address risk factors, and evaluate its impact on daily life.MethodsWe evaluated 1208 IBD patients from the Swiss Inflammatory Bowel Disease Cohort Study (SIBDCS) and 414 healthy controls. Significant fatigue was defined as a visual analogue scale (VAS‐F, range 0‐10) score ≥ 4. Secondary endpoints were severity of fatigue and its impact on daily activities with the Fatigue Severity Scale (FSS), with a score ≥ 4 indicative of fatigue. Demographic, IBD‐related and psychiatric symptoms were assessed with a multivariate analysis of variance (MANOVA) model optimised for prediction of VAS‐F (primary outcome) and FSS scores.ResultsOverall, 672 IBD patients (55.6%) reported significant fatigue compared to 145 (35%) controls (OR 2.71; 95% CI 2.08‐3.54; P < 0.001). In IBD, fatigue also significantly affected daily activities (FSS ≥ 4; 405 (33.5%) IBD patients vs 81 (19.6%) controls, P < 0.001). In the MANOVA model, fatigue levels were associated with female gender (coefficient 0.839; 0.556 ‐ 1.123; P < 0.001), younger age at diagnosis (−0.031 per year; −0.042– −0.019; P < 0.001), shorter disease duration (−0.036 per year; −0.050– −0.022; P < 0.001), nocturnal diarrhoea (0.718; 0.295‐1.141; P = 0.001), low educational level (P = 0.034) and symptoms of depression and anxiety.ConclusionsFatigue is both more frequent and more severe in patients with IBD than in the general population.

Randomised clinical trial: Psychological intervention improves work productivity and daily activity by reducing abdominal pain and fatigue in Crohn's disease

“…37 The in- These findings are consistent with cross-sectional studies linking abdominal pain and fatigue to work and activity impairments in CD. 3,5,6,12 Moreover, although our intervention successfully reduced disease activity, as reported previously, 25 improvements in work and activity impairments following COBMINDEX were not attributable to changes in general disease symptoms, but rather to improvements specifically in patients' fatigue and abdominal pain; thus, further highlighting the importance of targeting these key symptoms in psychological and pharmacological treatments for CD.…”

“…2 A study of newly diagnosed patients with CD showed that fatigue was prevalent in 30% of the cohort. 3 Fatigue severity is higher in patients with CD than in healthy controls 4,5 and is associated with increased depression, anxiety and stress. 2,3,5,6 Fatigue is also associated with poor disease-specific quality of life.…”

“…2,3,5,6 Fatigue is also associated with poor disease-specific quality of life. 2,3,5,6 Consistent with this, fatigue has been identified as a leading concern for patients with CD that has a significant impact on their everyday life. 7 Current evidence on the efficacy of pharmacological CD therapy in the management of fatigue is limited, and some medications for the treatment of CD may even exacerbate fatigue.…”

“…3 Fatigue severity is higher in patients with CD than in healthy controls 4,5 and is associated with increased depression, anxiety and stress. 2,3,5,6 Fatigue is also associated with poor disease-specific quality of life. 2,3,5,6 Consistent with this, fatigue has been identified as a leading concern for patients with CD that has a significant impact on their everyday life.…”

“…20 Fatigue and abdominal pain severity are particularly associated with increased loss of work productivity and activity impairment. 3,5,6,12 A growing body of clinical data supports the presence of a bidirectional relationship between the central nervous system and the gastrointestinal system, known as the gut-brain axis. 21,22 Within this biopsychosocial framework, it has been proposed that psychological stress can contribute to relapse and exacerbation of CD symptoms.…”