We did not find any evidence to indicate that prophylaxis with GM-CSF mouthwash can help to reduce the severity of mucositis in the setting of the patients we studied.

Objective: Fatigue is frequently reported by patients with inflammatory bowel disease (IBD), irrespective of disease activity; however, evidence regarding fatigue management is limited. This study tested the effect of individualised advice to increase physical activity and/or omega-3 fatty acids supplementation on fatigue in inactive IBD. Methods:Patients in remission were recruited to a pilot study utilising a randomised Results: From n=656 screened patients, n=74 who met the eligibility criteria (designed to remove confounding factors) were randomised, n=60 commenced, and n=52 completed the study. The primary outcome, fatigue measured with FACIT-F score, was worse with omega-3 supplementation (95%CI:-8.6-(-0.7);p=0.02), and unchanged with exercise advice (p=0.38). Fatigue, measured by IBD-F score, was reduced with exercise 2 advice (95%CI:-3.8-(-0.2);p=0.03). One treatment-related adverse event (musculoskeletal pain) was reported with exercise. Conclusions:Advice to increase physical activity and omega-3 supplementation, singly or in combination, were shown to be well-tolerated in IBD patients in remission. There was no evidence of exercise-related adverse effects on gut symptoms. Fatigue (IBD-F score) was reduced with exercise advice, but fatigue (FACIT-F score) was unchanged.Increasing fatigue with omega-3 supplementation is unexplained. Regular exercise may be a self-management option in IBD-related fatigue.

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