Review article: The aetiology of fatigue in inflammatory bowel disease and potential therapeutic management strategies

Abstract

Background: Fatigue is the inability to achieve or maintain an expected work output resulting from central or peripheral mechanisms. The prevalence of inflammatory bowel disease (IBD) fatigue can reach 86% in active disease, persisting in 50%-52% of patients with mild to inactive disease. Fatigue is the commonest reason for work absence in IBD, and patients often report fatigue burden to be greater than that of primary disease symptoms. Relatively few evidence-based treatment options exist, and the aetiology is poorly understood. Aim:To review the available data and suggest a possible aetiology of IBD fatigue and to consider the efficacy of existing management strategies and highlight potential future interventions. Methods:We reviewed fatigue-related literature in IBD using PubMed database. Results: Disease related factors such as inflammation and pharmacological treatments negatively impact skeletal muscle and brain physiology, likely contributing to fatigue symptoms. Secondary factors such as malnutrition, anaemia, sleep disturbance and psychological comorbidity are potential determinants. Immune profile, faecal microbiota composition and physical fitness differ significantly between fatigued and non-fatigued patients, suggesting these may be aetiological factors. Solution-focused therapy, high-dosage thiamine supplementation and biological therapy may reduce fatigue perception in IBD. The effect of physical activity interventions is inconclusive. Conclusions: A multimodal approach is likely required to treat IBD fatigue. Established reversible factors like anaemia, micronutrient deficiencies and active disease should initially be resolved. Psychosocial intervention shows potential efficacy in reducing fatigue perception in quiescent disease. Restoring physical deconditioning by exercise training intervention may further improve fatigue burden.| 369 MCGING et al.

Associations between inflammatory bowel disease, social isolation, and mortality: evidence from a longitudinal cohort study

“…42 Integrating psychological support into IBD care is warranted. 43 Notably, despite patients with CD might more likely to withdraw from work and socialize less often due to more severe fatigue 44,45 and perceived burden 46 reported than in those with UC, more attention need to be paid on them to mitigate the long-term effects; (2) support groups for patients with IBD should be encouraged to help increase social interaction and improve coping strategies 3,47 ; and (3) both patients and the public should be educated with relevant information to bridge the knowledge gap, improve understanding, and reduce the stigma associated with IBD. 6 Although we performed the rigorous statistical study with a series of sensitivity analyses, our findings still need to be interpreted with caution in light of several limitations.…”

PharmaNews

“…Die Fatigue ist mit 51% der häufigste Grund für eine Arbeitsunfähigkeit bei CED. Betroffene geben zudem häufig an, sich von ihrer Fatigue stärker beeinträchtigt zu fühlen als von Stuhldrang und Diarrhö [6].…”

Trajectories of health‐related quality of life and fatigue during vedolizumab therapy in inflammatory bowel disease

“…2 For example, fatigue is reported by most patients with active disease but a substantial proportion experience significant persistent fatigue also during remission. [3][4][5][6] QoL and fatigue are particular strong determinants for work productivity loss in IBD and thus major contributors to indirect disease related costs. [7][8][9] Accordingly, a "treat-to-target" strategy involves assessments and optimizations of disease activity as well as QoL and disabilities.…”