Psychological distress, iron deficiency, active disease and female gender are independent risk factors for fatigue in patients with ulcerative colitis

Jonefjäll, Börje; Simrén, Magnus; Lasson, Anders; Öhman, Lena; Strid, Hans

doi:10.1177/2050640617703868

Cited by 33 publications

(40 citation statements)

References 44 publications

(155 reference statements)

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“…In our study, women reported significantly higher anxiety testscores than men, which is corroborated by previous studies [46,47]. We did not find an association with ID or inflammation, although another study found that disorders such as anxiety or depression, disease activity, and gender are independent risk factors for fatigue in IBD [48].…”

Section: Discussionsupporting

confidence: 92%

Iron deficiency, depression, and fatigue in inflammatory bowel diseases

König¹,

Jimenez²,

Saletu-Zyhlarz³

et al. 2020

Z Gastroenterol

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Background Iron deficiency and anemia are common findings in IBD. Treatment of anemia improves quality of life. Neurological symptoms like depression or anxiety are also common in IBD; however, their relationship with ID has not been studied in detail. Methods Prospective, single center, non-interventional trial in an IBD cohort (n = 98), which is generally at risk for ID. Quality of sleep (using the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, and Insomnia Severity Index) and the presence of fatigue (Piper fatigue scale), depression (Self-rating Depression Scale [SDS]) or anxiety (Self-rating Anxiety Scale [SAS]) were related to ID (ferritin, transferrin saturation), anemia (hemoglobin), and inflammatory disease activity (CRP). Results ID was present in 35 %, anemia in 16 %, and inflammation in 30 %. The overall quality of sleep in this cohort was similar to that reported for the general population. ID, anemia, or inflammation had no influence on the PSQI (median 4.0 [CI 3.0–5.0]), the ESS 5.5 (5.0–7.0), and the ISI 4.00 (2.5–5.5). Fatigue (PFS; present in 30 %), anxiety (SAS; present in 24 %), and depression (SDS; present in 33 %) were more common than in the general population. Iron deficient and anemic patients were more likely to be depressed (p = 0.02 and p < 0.01) and showed a trend towards presence of fatigue (p = 0.06 and 0.07). Systemic inflammation as measured by CRP had no effect on any of these conditions. Conclusion In this IBD cohort, ID and anemia affect depression and possibly fatigue independent of the presence of inflammation.

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Section: Discussionsupporting

confidence: 92%

Iron deficiency, depression, and fatigue in inflammatory bowel diseases

König¹,

Jimenez²,

Saletu-Zyhlarz³

et al. 2020

Z Gastroenterol

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“…However, these studies did not determine endoscopic or biochemical remission, making it difficult to determine underlying IBD-related inflammatory burden accurately. One study (n = 288), in which fatigue was assessed during active disease and during deep remission, those in deep remission had no significant difference in immune markers, i.e., calprotectin, C-reactive protein (CRP), IL-17A, IL-6, IL-1b, IL-10, IL-8, TNFa, IL-13, IFN, IL-4, and IL-12, between those with fatigue and those without fatigue [9]. Thus, in quiescent disease, inflammation may not have a significant role in the pathogenesis of fatigue.…”

Section: Pro-inflammatory Statementioning

confidence: 99%

“…Thus, in quiescent disease, inflammation may not have a significant role in the pathogenesis of fatigue. However, active IBD with elevated cytokines, such as TNFa and IFNc, as well as elevated fecal calprotectin, correlates with the severity of fatigue [5,6,9,29,[32][33][34].…”

Section: Pro-inflammatory Statementioning

confidence: 99%

“…In another cross-sectional study of 247 patients with IBD, lack of energy was the most burdensome symptom, more so than gastrointestinal complaints, such as diarrhea [8]. Fatigue occurs in patients with IBD of all ages and both sexes, although some studies suggest a greater burden in women [9]. It is also associated with lack of education beyond primary school, part-time work schedule, and other comorbid conditions [10].…”

Section: Introductionmentioning

confidence: 99%

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Fatigue in Inflammatory Bowel Diseases: Etiologies and Management

et al. 2019

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Fatigue is a burdensome, multidimensional, and multifactorial symptom that is associated with a wide array of chronic illnesses, specifically occurring in nearly 50% of patients with inflammatory bowel disease (IBD). Although common, given its subjective nature, physicians often under-recognize and undertreat this debilitating symptom. There are multiple etiologies that can contribute to fatigue in patients with IBD, including disease activity, anemia, medications, psychosomatic symptoms, and alterations to the gut-brain axis. The management of fatigue in IBD can be challenging, as it is often times multifaceted. In this review, we summarize the available tools for the diagnosis and measurement of fatigue, discuss etiologies, and make recommendations for their management. We identify knowledge gaps for the workup and treatment of fatigue and propose an algorithm to aid physicians in the evaluation and management of fatigue in this unique population. However, future research is needed to address several areas of knowledge deficits and improve the management of fatigue in IBD.

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“…Abdominal pain, diarrhea, weight reduction, and chronic fatigue are the main clinical characteristics of IBD, which significantly impair the quality of patients' life. Recent data have demonstrated that the chronic fatigue of patients is often closely associated with anemia [1, 2]. Although often neglected, anemia is known as the most frequent comorbidity of IBD [3], which may progress in the course of inflammatory response, intestinal bleeding, disorders of iron absorption [4, 5], vitamin B12 and folate deficiency, drug-related side effects, and hematologic diseases [6–8].…”

Section: Introductionmentioning

confidence: 99%

Anti-TNF-α Monoclonal Antibody Therapy Improves Anemia through Downregulating Hepatocyte Hepcidin Expression in Inflammatory Bowel Disease

Shu

Pang

et al. 2019

Mediators of Inflammation

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Anemia is one of the most common complications in patients with inflammatory bowel disease (IBD). Hepcidin as a key regulator of iron metabolism is pivotal in mediating the occurrence of anemia of chronic disease. Herein, we analyzed the levels of hepcidin in sera from IBD patients by enzyme-linked immunosorbent assay and investigated its potential role in regulating the anemia in IBD. We observed that the levels of serum hepcidin were increased in active IBD patients compared with those in remitted IBD patients and healthy controls and that serum hepcidin was associated with disease activity, CRP, and ESR, respectively. Importantly, we found that the increased levels of serum hepcidin were positively correlated with the severity of anemia and the imbalance of iron metabolism in anemic UC and CD patients. Proinflammatory factors (e.g., IL-6, IL-17, and TNF-α) were positively correlated with the concentrations of serum hepcidin in IBD patients. Interestingly, hepcidin was found to be decreased in patients with Crohn's disease after successful therapy with anti-TNF-α mAb (i.e., infliximab), indicating the underlying association between TNF-α and hepcidin expression. To investigate the specific mechanisms involved, we cultured LO2 and HepG2 cell lines in vitro under stimulation with TNF-α and observed that the levels of hepcidin mRNA were markedly upregulated in caspase-3/8- and NF-κB-dependent manners. Therefore, our data suggest that TNF-α stimulates the expression of hepcidin in IBD patients, resulting in aggravated anemia and that blockage of TNF-α or the caspase-3/8 and NF-κB pathways could downregulate hepcidin expression. This study provides inspiration for the therapy and management of anemia in IBD.

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Psychological distress, iron deficiency, active disease and female gender are independent risk factors for fatigue in patients with ulcerative colitis

Abstract: Probable psychiatric disorder, iron deficiency, active disease and female gender are independent risk factors for high fatigue in patients with ulcerative colitis. Low-grade immune activity does not seem to be the cause of fatigue among patients in deep remission.

Cited by 33 publications

References 44 publications

Iron deficiency, depression, and fatigue in inflammatory bowel diseases

Iron deficiency, depression, and fatigue in inflammatory bowel diseases

Fatigue in Inflammatory Bowel Diseases: Etiologies and Management

Anti-TNF-α Monoclonal Antibody Therapy Improves Anemia through Downregulating Hepatocyte Hepcidin Expression in Inflammatory Bowel Disease

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