Substantial Fatigue Associated With Increased IBD Disease Activity 

Patients newly diagnosed with inflammatory bowel disease (IBD) often experience substantial fatigue, according to study findings published in the Journal of Crohn’s and Colitis. 

The pathogenesis of fatigue secondary to IBD has not been well documented. Researchers conducted the Inflammatory Bowel Disease in South-Eastern Norway III (IBSEN III) study (ClinicalTrials.gov Identifier: NCT02727959) to assess the factors associated with fatigue among patients with IBD. 

IBSEN III is a prospective, population-based cohort study focused on patients diagnosed with IBD from 2017 through 2019. The researchers conducted a fecal calprotectin analysis and colonoscopy on all patients.

Disease activity was based on c-reactive protein (CRP) and fecal calprotectin levels. Crohn disease (CD) activity levels were measured using the Harvey-Bradshaw index (HBI) and ulcerative colitis (UC) activity levels were measured using the Simple Clinical Colitis Activity Index (SCCAI). 

Fatigue questionnaires (FQ) were distributed to patients, and higher FQ scores indicated higher fatigue levels. 

A total of 1,561 patients with IBD aged 18 years and older were considered for analysis. Of these patients, 1,003 (64.3%) were diagnosed with UC and 506 (32.4%) were diagnosed with CD. After the exclusion of patients with incomplete data, 983 patients remained in the analysis.

There was a higher proportion of patients with substantial fatigue among patients with CD (69.6%), compared with patients with UC (60.2%). This trend was observed for total fatigue as well, with 5.5% for CD and 5.4% for UC.

For both UC (60.2%) and CD (69.6%), substantial fatigue was higher than that of the general Norwegian population (P <.01). 

Univariate analysis revealed that increased total fatigue was significantly associated with increased disease activity. While increased total fatigue was associated with decreased hemoglobin levels for both CD and UC, using established anemia cut-offs for hemoglobin showed no differences in fatigue scores. 

There was a significant increase in fecal calprotectin among patients with UC (P <.05). However, this association was not significant when using the established cut-off for active inflammation (>250 μg/g). 

“[T]he burden of substantial fatigue in patients newly diagnosed with IBD is considerable, affecting approximately two-thirds of patients,” study authors wrote. “Depressive symptoms, sleep disturbances, and increased pain intensity were strongly associated with fatigue in both patients with UC and CD, while objective variables reflecting the severity of inflammation were found to be only independently associated with fatigue in patients with UC.”

Study limitations include potential selection bias, underestimation of the influence of fecal calprotectin, and the inability to quantify inflammatory changes in IBD. 

This article originally appeared on Gastroenterology Advisor