Fatigue in Inflammatory Bowel Disease

Abstract

Introduction: Fatigue is a common yet undertreated symptom in patients with Inflammatory Bowel Disease (IBD). Treating underlying inflammation lead to improved health outcomes and fatigue. However, fatigue can persist in remission.

Aim: The aim of this study is to investigate fatigue in IBD and relate to possible contributing factors.

Method: Patients were identified through the Episoft database. Following consent, all patients were provided with a questionnaire regarding demographics, International Physical Activity Questionnaire, CDAI and SCCAI, Brief Fatigue Inventory (BFI), multi-dimensional Fatigue Inventory (MFI). Patients were asked to complete a full blood count and faecal calprotectin (FCP). Fatigued remission patients without evidence of anaemia and with depleted iron stores (serum ferritin <50µg/L) were given 500mg of i.v. iron as Ferinject with follow up four weeks later.

Results: 68/113 (60.2%) patients had active and 45/113 (39.8%) quiescent disease. Depending on the questionnaire used 55% of active and 44.5% of quiescence disease experienced moderate to sever fatigue, while 77.9% of active and 46.7% of quiescent disease experienced problamatic fatigue (MF) (all p<0.001). Disease indices and FCP but not CRP were significantly associated with fatigue. Younger patients, females, those with a shorter time since diagnosis and patients following a diet complained of more fatigue. There was no significant difference between diseases. Patients in remission but with depleted iron stores (n=13) complained of significantly more fatigue than those with sufficient iron stores (p=0.012). Of those, 7 patients received i.v. iron leading to significant improvement in fatigue levels after four weeks.

Conclusion: Fatigue is multifactorial and highly prevalent in IBD even in remission. Reduced serum ferritin is associated with fatigue also in remission.