1
|
Bernstein CN, Fisk JD, Dolovich C, Hitchon CA, Graff LA, El-Gabalawy R, Lix LM, Bolton JM, Patten SB, Marrie RA. Understanding Predictors of Fatigue Over Time in Persons With Inflammatory Bowel Disease: The Importance of Depressive and Anxiety Symptoms. Am J Gastroenterol 2024; 119:922-929. [PMID: 38088416 DOI: 10.14309/ajg.0000000000002630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/06/2023] [Indexed: 01/26/2024]
Abstract
INTRODUCTION Fatigue is a complex and frequent symptom in persons with inflammatory bowel disease (IBD), with detrimental impact. We aimed to determine predictors of fatigue over time. METHODS Two hundred forty-seven adults with IBD participated in a prospective study conducted in Manitoba, Canada, providing data at baseline and annually for 3 years. Participants reported fatigue impact (Daily Fatigue Impact Scale [DFIS]), depression and anxiety symptoms (Hospital Anxiety and Depression Scale [HADS]), and pain (Pain Effects Scale [PES]). Physician-diagnosed comorbidities, IBD characteristics, and physical and cognitive functioning were also assessed. We tested factors associated with fatigue using multivariable generalized linear models that estimated within-person and between-person effects. RESULTS Most participants were women (63.2%), White (85.4%), and had Crohn's disease (62%). At baseline, 27.9% reported moderate-severe fatigue impact, 16.7% had clinically elevated anxiety (HADS-A ≥11), and 6.5% had clinically elevated depression (HADS-D ≥11). Overall fatigue burden was stable over time, although approximately half the participants showed improved or worsening fatigue impact between annual visits during the study. On multivariable analysis, participants with a one-point higher HADS-D score had, on average, a 0.63-point higher DFIS score, whereas participants with a one-point higher PES score had a 0.78-point higher DFIS score. Within individuals, a one-point increase in HADS-D scores was associated with 0.61-point higher DFIS scores, in HADS-A scores with 0.23-point higher DFIS scores, and in PES scores with 0.38-point higher DFIS scores. No other variables predicted fatigue. DISCUSSION Anxiety, depression, and pain predicted fatigue impact over time in IBD, suggesting that targeting psychological factors and pain for intervention may lessen fatigue burden.
Collapse
Affiliation(s)
- Charles N Bernstein
- Department of Medicine, Max Rady Faculty of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- University of Manitoba IBD Clinical and Research Centre
| | - John D Fisk
- Nova Scotia Health and the Departments of Psychiatry, Psychology & Neuroscience, and Medicine, Dalhousie University, Halifax, Canada
| | - Casandra Dolovich
- Department of Medicine, Max Rady Faculty of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Carol A Hitchon
- Department of Medicine, Max Rady Faculty of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Lesley A Graff
- University of Manitoba IBD Clinical and Research Centre
- Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Renée El-Gabalawy
- University of Manitoba IBD Clinical and Research Centre
- Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Lisa M Lix
- University of Manitoba IBD Clinical and Research Centre
- Department of Community Health Sciences, Max Rady Faculty of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - James M Bolton
- University of Manitoba IBD Clinical and Research Centre
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Scott B Patten
- Departments of Community Health Sciences & Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Ruth Ann Marrie
- Department of Medicine, Max Rady Faculty of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- University of Manitoba IBD Clinical and Research Centre
- Department of Community Health Sciences, Max Rady Faculty of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| |
Collapse
|
2
|
Zhijia S, Meijuan X, Yanting Z, Fang L, Minyu F, Ruirui C, Li C, Jingyan Z, Limei Y. Illness Perceptions as a Predictor of Symptom Cluster Trajectories in Patients With Inflammatory Bowel Disease: A Latent Growth Mixture Model. Gastroenterol Nurs 2024; 47:111-121. [PMID: 38567854 DOI: 10.1097/sga.0000000000000793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 09/20/2023] [Indexed: 04/05/2024] Open
Abstract
The aims of this study were to (a) identify the trajectory of symptom clusters in patients with inflammatory bowel disease up to 28 weeks after initiation of infliximab therapy and (b) examine the illness perceptions associated with symptom cluster trajectories. This was a prospective study where participants completed the symptom cluster scale at baseline, 14 weeks, and 28 weeks. A latent growth mixture modeling was used to identify trajectories of symptom clusters that were predicted, using baseline covariates (Brief Illness Perception Questionnaire). A total of 206 patients were included and identified as three latent classes: moderate symptom cluster-stable decline group (C1), high symptom cluster-rapid decline group (C2), and stable symptom cluster-stable trend group (C3). C1 was predicted by cognitive illness perceptions (odds ratio [95% confidence interval]: 1.134 [1.071, 1.200], p < .001). C2 was also predicted by cognitive and emotional illness perceptions (odds ratio [95% confidence interval]: 1.169 [1.095, 1.248], p < .001; odds ratio [95% confidence interval]: 1.174 [1.038, 1.328], p = .011). Patients with inflammatory bowel disease, initiating infliximab therapy, had different symptom cluster trajectories. Illness perceptions were associated with symptom cluster classes, which underline the complexity of symptoms. Paying attention to these factors and providing necessary knowledge and psychological supporting care after infliximab therapy would effectively improve patients' symptom burden.
Collapse
Affiliation(s)
- Shen Zhijia
- Shen Zhijia, MSN, RN, is a Registered Nurse, Gastroenterology Department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
- Xi Meijuan, MM, is Gastroenterologist, Gastroenterology Department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
- Zhou Yanting, BSN, RN, is a Head Nurse in Gastroenterology, Gastroenterology Department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
- Li Fang, MM, is Gastroenterologist, Gastroenterology Department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
- Fan Minyu, MM, is Gastroenterologist, Oncology department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
- Chen Ruirui, MSN, RN, is a Registered Nurse, School of Medicine, Jiangsu University, Zhenjiang, China, and Gastroenterology Department, General Hospital of Eastern Theater Command, Jiangsu, China
- Chen Li, BSN, RN, is a Clinical Nurse Specialist, Nursing Department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
- Zhong Jingyan, BSN, RN, is a Clinical Nurse Specialist, Nursing Department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
- Yin Limei, BSN, RN, is a Head of the Nursing Department, Nursing Department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
| | - Xi Meijuan
- Shen Zhijia, MSN, RN, is a Registered Nurse, Gastroenterology Department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
- Xi Meijuan, MM, is Gastroenterologist, Gastroenterology Department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
- Zhou Yanting, BSN, RN, is a Head Nurse in Gastroenterology, Gastroenterology Department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
- Li Fang, MM, is Gastroenterologist, Gastroenterology Department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
- Fan Minyu, MM, is Gastroenterologist, Oncology department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
- Chen Ruirui, MSN, RN, is a Registered Nurse, School of Medicine, Jiangsu University, Zhenjiang, China, and Gastroenterology Department, General Hospital of Eastern Theater Command, Jiangsu, China
- Chen Li, BSN, RN, is a Clinical Nurse Specialist, Nursing Department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
- Zhong Jingyan, BSN, RN, is a Clinical Nurse Specialist, Nursing Department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
- Yin Limei, BSN, RN, is a Head of the Nursing Department, Nursing Department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
| | - Zhou Yanting
- Shen Zhijia, MSN, RN, is a Registered Nurse, Gastroenterology Department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
- Xi Meijuan, MM, is Gastroenterologist, Gastroenterology Department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
- Zhou Yanting, BSN, RN, is a Head Nurse in Gastroenterology, Gastroenterology Department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
- Li Fang, MM, is Gastroenterologist, Gastroenterology Department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
- Fan Minyu, MM, is Gastroenterologist, Oncology department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
- Chen Ruirui, MSN, RN, is a Registered Nurse, School of Medicine, Jiangsu University, Zhenjiang, China, and Gastroenterology Department, General Hospital of Eastern Theater Command, Jiangsu, China
- Chen Li, BSN, RN, is a Clinical Nurse Specialist, Nursing Department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
- Zhong Jingyan, BSN, RN, is a Clinical Nurse Specialist, Nursing Department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
- Yin Limei, BSN, RN, is a Head of the Nursing Department, Nursing Department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
| | - Li Fang
- Shen Zhijia, MSN, RN, is a Registered Nurse, Gastroenterology Department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
- Xi Meijuan, MM, is Gastroenterologist, Gastroenterology Department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
- Zhou Yanting, BSN, RN, is a Head Nurse in Gastroenterology, Gastroenterology Department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
- Li Fang, MM, is Gastroenterologist, Gastroenterology Department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
- Fan Minyu, MM, is Gastroenterologist, Oncology department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
- Chen Ruirui, MSN, RN, is a Registered Nurse, School of Medicine, Jiangsu University, Zhenjiang, China, and Gastroenterology Department, General Hospital of Eastern Theater Command, Jiangsu, China
- Chen Li, BSN, RN, is a Clinical Nurse Specialist, Nursing Department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
- Zhong Jingyan, BSN, RN, is a Clinical Nurse Specialist, Nursing Department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
- Yin Limei, BSN, RN, is a Head of the Nursing Department, Nursing Department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
| | - Fan Minyu
- Shen Zhijia, MSN, RN, is a Registered Nurse, Gastroenterology Department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
- Xi Meijuan, MM, is Gastroenterologist, Gastroenterology Department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
- Zhou Yanting, BSN, RN, is a Head Nurse in Gastroenterology, Gastroenterology Department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
- Li Fang, MM, is Gastroenterologist, Gastroenterology Department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
- Fan Minyu, MM, is Gastroenterologist, Oncology department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
- Chen Ruirui, MSN, RN, is a Registered Nurse, School of Medicine, Jiangsu University, Zhenjiang, China, and Gastroenterology Department, General Hospital of Eastern Theater Command, Jiangsu, China
- Chen Li, BSN, RN, is a Clinical Nurse Specialist, Nursing Department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
- Zhong Jingyan, BSN, RN, is a Clinical Nurse Specialist, Nursing Department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
- Yin Limei, BSN, RN, is a Head of the Nursing Department, Nursing Department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
| | - Chen Ruirui
- Shen Zhijia, MSN, RN, is a Registered Nurse, Gastroenterology Department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
- Xi Meijuan, MM, is Gastroenterologist, Gastroenterology Department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
- Zhou Yanting, BSN, RN, is a Head Nurse in Gastroenterology, Gastroenterology Department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
- Li Fang, MM, is Gastroenterologist, Gastroenterology Department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
- Fan Minyu, MM, is Gastroenterologist, Oncology department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
- Chen Ruirui, MSN, RN, is a Registered Nurse, School of Medicine, Jiangsu University, Zhenjiang, China, and Gastroenterology Department, General Hospital of Eastern Theater Command, Jiangsu, China
- Chen Li, BSN, RN, is a Clinical Nurse Specialist, Nursing Department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
- Zhong Jingyan, BSN, RN, is a Clinical Nurse Specialist, Nursing Department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
- Yin Limei, BSN, RN, is a Head of the Nursing Department, Nursing Department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
| | - Chen Li
- Shen Zhijia, MSN, RN, is a Registered Nurse, Gastroenterology Department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
- Xi Meijuan, MM, is Gastroenterologist, Gastroenterology Department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
- Zhou Yanting, BSN, RN, is a Head Nurse in Gastroenterology, Gastroenterology Department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
- Li Fang, MM, is Gastroenterologist, Gastroenterology Department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
- Fan Minyu, MM, is Gastroenterologist, Oncology department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
- Chen Ruirui, MSN, RN, is a Registered Nurse, School of Medicine, Jiangsu University, Zhenjiang, China, and Gastroenterology Department, General Hospital of Eastern Theater Command, Jiangsu, China
- Chen Li, BSN, RN, is a Clinical Nurse Specialist, Nursing Department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
- Zhong Jingyan, BSN, RN, is a Clinical Nurse Specialist, Nursing Department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
- Yin Limei, BSN, RN, is a Head of the Nursing Department, Nursing Department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
| | - Zhong Jingyan
- Shen Zhijia, MSN, RN, is a Registered Nurse, Gastroenterology Department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
- Xi Meijuan, MM, is Gastroenterologist, Gastroenterology Department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
- Zhou Yanting, BSN, RN, is a Head Nurse in Gastroenterology, Gastroenterology Department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
- Li Fang, MM, is Gastroenterologist, Gastroenterology Department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
- Fan Minyu, MM, is Gastroenterologist, Oncology department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
- Chen Ruirui, MSN, RN, is a Registered Nurse, School of Medicine, Jiangsu University, Zhenjiang, China, and Gastroenterology Department, General Hospital of Eastern Theater Command, Jiangsu, China
- Chen Li, BSN, RN, is a Clinical Nurse Specialist, Nursing Department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
- Zhong Jingyan, BSN, RN, is a Clinical Nurse Specialist, Nursing Department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
- Yin Limei, BSN, RN, is a Head of the Nursing Department, Nursing Department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
| | - Yin Limei
- Shen Zhijia, MSN, RN, is a Registered Nurse, Gastroenterology Department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
- Xi Meijuan, MM, is Gastroenterologist, Gastroenterology Department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
- Zhou Yanting, BSN, RN, is a Head Nurse in Gastroenterology, Gastroenterology Department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
- Li Fang, MM, is Gastroenterologist, Gastroenterology Department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
- Fan Minyu, MM, is Gastroenterologist, Oncology department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
- Chen Ruirui, MSN, RN, is a Registered Nurse, School of Medicine, Jiangsu University, Zhenjiang, China, and Gastroenterology Department, General Hospital of Eastern Theater Command, Jiangsu, China
- Chen Li, BSN, RN, is a Clinical Nurse Specialist, Nursing Department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
- Zhong Jingyan, BSN, RN, is a Clinical Nurse Specialist, Nursing Department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
- Yin Limei, BSN, RN, is a Head of the Nursing Department, Nursing Department, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, SuZhou, China
| |
Collapse
|
3
|
Kim YJ, Lee SG, Lee JS, Choi YJ, Son CG. Comparative characteristics of fatigue in irritable bowel syndrome and inflammatory bowel disease: A systematic review and meta-analysis. J Psychosom Res 2024; 177:111589. [PMID: 38199049 DOI: 10.1016/j.jpsychores.2024.111589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/30/2023] [Accepted: 01/04/2024] [Indexed: 01/12/2024]
Abstract
OBJECTIVE Fatigue is a common symptom in both irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC). This study aimed to distinguish fatigue characteristics in IBS and IBD, two functional and organic disorders. METHODS We systematically searched the PubMed and Cochrane Library databases from inception to June 30, 2023, and conducted a meta-analysis to generate precise estimates and 95% confidence intervals. The analyses were stratified by fatigue type, severity, sex, disease phase, and comorbidities, and study quality was assessed using Newcastle-Ottawa Scale (NOS). RESULTS Our analysis included 74 data (13 IBS, 31 CD, 30 UC) encompassing 16,689 participants (6484 males, 7402 females, and 2803 unknown). Overall, fatigue prevalence trended higher in IBS (54.5% [95%CI, 44.5-64.6]), followed by CD (49.8% [95%CI, 44.0-55.5]) and UC (43.6% [95%CI, 38.5-48.7]). This pattern persisted across sub-analyses, including general fatigue (63.4% vs. 51.3% vs. 45.3%) and moderate to severe fatigue (73.8% vs. 59.5% vs. 52.7%) for IBS, CD, and UC, respectively. Female predominance was observed in all three diseases (odds ratio: 1.5 in IBS and CD, 1.8 in UC). Fatigue prevalence significantly varied between disease phases (active vs. remission) in CD (61.3% vs. 36.3%) and UC (53.8% vs. 32.6%). Anemia, anxiety/depression, and/or IBS-like symptoms also contributed to fatigue in CD and UC. CONCLUSIONS This study is the first extensive comparison of fatigue prevalence and features in IBS, CD, and UC. The findings offer valuable insights for treatment and management, aiding our understanding of functional and organic diseases.
Collapse
Affiliation(s)
- Yeon-Jae Kim
- Korean Medical College of Daejeon University, 62, Daehak-ro, Dong-gu, Daejeon 34520, Republic of Korea
| | - Seul-Gi Lee
- Korean Medical College of Daejeon University, 62, Daehak-ro, Dong-gu, Daejeon 34520, Republic of Korea
| | - Jin-Seok Lee
- Research Center for CFS/ME, Daejeon Oriental Hospital of Daejeon University, 176 Daedeokdae-ro, Seo-gu, Daejeon 35235, Republic of Korea
| | - Yu-Jin Choi
- Research Center for CFS/ME, Daejeon Oriental Hospital of Daejeon University, 176 Daedeokdae-ro, Seo-gu, Daejeon 35235, Republic of Korea
| | - Chang-Gue Son
- Research Center for CFS/ME, Daejeon Oriental Hospital of Daejeon University, 176 Daedeokdae-ro, Seo-gu, Daejeon 35235, Republic of Korea; Institute of Bioscience and Integrative Medicine, Daejeon University, 62 Daehak-ro, Dong-gu, Daejeon 34520, Republic of Korea.
| |
Collapse
|
4
|
Bergamaschi G, Castiglione F, D'Incà R, Astegiano M, Fries W, Milla M, Ciacci C, Rizzello F, Saibeni S, Ciccocioppo R, Orlando A, Bossa F, Principi M, Vernia P, Ricci C, Scribano ML, Bodini G, Mazzucco D, Bassotti G, Riegler G, Buda A, Neri M, Caprioli F, Monica F, Manca A, Villa E, Fiorino G, Aronico N, Lenti MV, Mengoli C, Testa A, Vecchi M, Klersy C, Di Sabatino A. Follow-up evaluation and management of anemia in inflammatory bowel disease: A study by the Italian Group for Inflammatory Bowel Diseases (IG-IBD). Dig Liver Dis 2024:S1590-8658(24)00193-2. [PMID: 38296690 DOI: 10.1016/j.dld.2024.01.176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/04/2024] [Accepted: 01/04/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND The RIDART I study found a 13.6% prevalence of anemia in Italian patients with inflammatory bowel disease (IBD); most cases were due to iron-deficiency anemia (IDA). AIMS To evaluate changes in hemoglobin concentration during a 24-week follow-up of anemic patients with IBD. METHODS Follow-up laboratory and clinical data were obtained from RIDART I study patients with anemia. Factors affecting hemoglobin concentration, the impact of anemia on fatigue and quality of life (QoL), and its relationship with treatment, disease activity and disease complications were investigated. RESULTS Hemoglobin was 108 g/L at baseline, increased to 121 g/L at follow-up week 12 (p < 0.001) and then stabilized until week 24, but most patients remained anemic, with IDA, throughout the study. Hemoglobin improvement was greater in patients receiving either oral or parenteral iron supplementation. Following hemoglobin normalization, anemia relapse rate during follow-up was 30%. Oral iron did not cause disease reactivation. Lower follow-up hemoglobin was associated with a higher probability of having active disease, clinical complications, increased fatigue and reduced QoL. CONCLUSIONS In anemic patients with IBD, anemia represents a long-lasting problem, in most cases persisting for up to 24 weeks, with high relapse rate and a negative impact on fatigue and QoL.
Collapse
Affiliation(s)
- Gaetano Bergamaschi
- Medicina Generale I, Fondazione IRCCS Policlinico San Matteo e Università di Pavia, 27100 Pavia, Italy.
| | - Fabiana Castiglione
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, 80138 Naples, Italy
| | - Renata D'Incà
- Inflammatory Bowel disease Unit- AO-University of Padua, 35122 Padova, Italy
| | - Marco Astegiano
- Gastroenterology and Digestive Endoscopy Unit, "Città della Salute e della Scienza" Hospital, 10126 Torino, Italy
| | - Walter Fries
- Gastroenterology and Clinical Unit for inflammatory bowel diseases, Dept. of Clinical and Experimental Medicine; University of Messina, 98122 Messina, Italy
| | - Monica Milla
- Unità operativa complessa di Gastroenterologia clinica, Azienda ospedaliero universitaria Careggi- Firenze, 50134 Firenze, Italy
| | - Carolina Ciacci
- Gastroenterology and Endoscopy Unit, AOU San Giovanni di Dio e Ruggi d'Aragona and University of Salerno, 84084 Salerno, Italy
| | - Fernando Rizzello
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Simone Saibeni
- Gastroenterology Unit, Rho Hospital, ASST Rhodense, 20017 Rho (MI), Italy
| | - Rachele Ciccocioppo
- Gastroenterology Unit, Department of Medicine, A.O.U.I. Policlinico G.B. Rossi & University of Verona, 37134 Verona, Italy
| | - Ambrogio Orlando
- Inflammatory Bowel Disease Unit, A.O.O.R. "Villa Sofia-Cervello", 90146 Palermo Italy
| | - Fabrizio Bossa
- Department of Gastroenterology and Endoscopy, Fondazione "Casa Sollievo della Sofferenza", IRCCS, 71013 San Giovanni Rotondo, Italy
| | | | - Piero Vernia
- Division of Gastroenterology, Department of Translational and Precision Medicine, "Sapienza" University of Rome and Umberto I Hospital, 00161 Rome, Italy
| | - Chiara Ricci
- Dept of Experimental and Clinical Science, University of Brescia, Gastroenterology Unit,Spedali Civili Hospital, 25123 Brescia. Italy
| | - Maria L Scribano
- Gastroenterology and Endoscopy Unit, Azienda Ospedaliera San Camillo-Forlanini, 00152 Rome, Italy; Villa Stuart, Multi-Speciality Clinic, 00135 Rome, Italy
| | - Giorgia Bodini
- Gastroenterology unit, Department of Internal medicine, Policlinico San Martino, Università di Genova, 16132 Genoa, Italy
| | - Dario Mazzucco
- Gastroenterology Unit, ASL TO3, 10097 Rivoli, Torino, Italy
| | - Gabrio Bassotti
- Gastroenterology, Hepatology & Digestive Endoscopy Section, Department of Medicine & Surgery, University of Perugia and Perugia General Hospital, 06129 Perugia, Italy
| | - Gabriele Riegler
- Unit of Gastroenterology - Reference Center for IBD - Second University of Naples, 80138 Naples, Italy
| | - Andrea Buda
- Department of Gastrointestinal Oncological Surgery, Gastroenterology Unit, S. Maria del Prato Hospital, 30032 Feltre, Italy
| | - Matteo Neri
- Department of Medicine and Ageing Sciences and Center for Advanced Studies and Technology (CAST), "G. d'Annunzio" University of Chieti-Pescara, 66013 Chieti, Italy
| | - Flavio Caprioli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico and Università degli Studi di Milano, 20122 Milan, Italy
| | - Fabio Monica
- Gastroenterology and Digestive Endoscopy Unit, Cattinara Academic Hospital, 34149 Trieste, Italy
| | - Aldo Manca
- Department of Gastroenterology and Digestive Endoscopy, S. Croce e Carle Hospital, 12100 Cuneo, Italy
| | - Erica Villa
- UC Gastroenterologia, Dipartimento di Specialità Mediche, Azienda Ospedaliera Universitaria di Modena, 41125 Modena, Italy
| | - Gionata Fiorino
- Department of Gastroenterology and Digestive Endoscopy, San Raffaele Hospital and Vita-Salute San Raffaele University, 20132 Milan, Italy; IBD Unit, San Camillo-Forlanini Hospital, 00152 Rome, Italy
| | - Nicola Aronico
- Medicina Generale I, Fondazione IRCCS Policlinico San Matteo e Università di Pavia, 27100 Pavia, Italy
| | - Marco V Lenti
- Medicina Generale I, Fondazione IRCCS Policlinico San Matteo e Università di Pavia, 27100 Pavia, Italy
| | - Caterina Mengoli
- Medicina Generale I, Fondazione IRCCS Policlinico San Matteo e Università di Pavia, 27100 Pavia, Italy
| | - Anna Testa
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, 80138 Naples, Italy
| | - Maurizio Vecchi
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico and Università degli Studi di Milano, 20122 Milan, Italy
| | - Catherine Klersy
- Servizio di Epidemiologia Clinica & Biometria, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Antonio Di Sabatino
- Medicina Generale I, Fondazione IRCCS Policlinico San Matteo e Università di Pavia, 27100 Pavia, Italy.
| |
Collapse
|
5
|
Holten KIA, Bernklev T, Opheim R, Johansen I, Olsen BC, Lund C, Strande V, Medhus AW, Perminow G, Bengtson MB, Cetinkaya RB, Vatn S, Frigstad SO, Aabrekk TB, Detlie TE, Hovde Ø, Kristensen VA, Småstuen MC, Henriksen M, Huppertz-Hauss G, Høivik ML, Jelsness-Jørgensen LP. Fatigue in Patients with Newly Diagnosed Inflammatory Bowel Disease: Results from a Prospective Inception Cohort, the IBSEN III Study. J Crohns Colitis 2023; 17:1781-1790. [PMID: 37279652 PMCID: PMC10673818 DOI: 10.1093/ecco-jcc/jjad094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/11/2023] [Accepted: 06/02/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND AND AIMS Although fatigue is common in inflammatory bowel disease [IBD], its pathogenesis remains unclear. This study aimed to determine the prevalence of fatigue and its associated factors in a cohort of patients newly diagnosed with IBD. METHODS Patients ≥18 years old were recruited from the Inflammatory Bowel Disease South-Eastern Norway [IBSEN III] study, a population-based, observational inception cohort. Fatigue was assessed using the Fatigue Questionnaire and compared with data from a Norwegian general population. Univariate and multivariate linear and logistic regression analyses were performed to evaluate the associations of total fatigue [TF; continuous score] and substantial fatigue [SF; dichotomized score ≥4] with sociodemographic, clinical, endoscopic, laboratory, and other relevant patient data. RESULTS In total, 983/1509 [65.1%] patients with complete fatigue data were included (ulcerative colitis [UC], 68.2%; Crohn's disease [CD], 31.8%). The prevalence of SF was higher in CD [69.6%] compared with UC [60.2%] [p < 0.01], and in both diagnoses when compared to the general population [p < 0.001]. In multivariate analyses, depressive symptoms, pain intensity, and sleep disturbances were associated with increased TF for both diagnoses. In addition, increased clinical disease activity and Mayo endoscopic score were significantly associated with TF in UC, whereas all disease-related variables were insignificant in CD. Similar findings were observed for SF, except regarding the Mayo endoscopic score. CONCLUSIONS SF affects approximately two-thirds of patients newly diagnosed with IBD. Fatigue was associated with depressive symptoms, sleep disturbances, and increased pain intensity in both diagnoses, while clinical and endoscopic activity were associated factors only in UC.
Collapse
Affiliation(s)
- Kristina I Aass Holten
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Gastroenterology, Østfold Hospital Trust, Sarpsborg, Norway
| | - Tomm Bernklev
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Research and Development Department, Vestfold Hospital Trust, Tønsberg, Norway
| | - Randi Opheim
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ingunn Johansen
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Health Sciences, Østfold University College, Halden, Norway
| | - Bjørn C Olsen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Gastroenterology, Telemark Hospital Trust, Skien, Norway
| | - Charlotte Lund
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
| | - Vibeke Strande
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Unger-Vetlesen Institute, Lovisenberg Diaconal Hospital, Oslo, Norway
- Department of Gastroenterology, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Asle W Medhus
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
| | - Gøri Perminow
- Pediatric Department, Oslo University Hospital, Oslo, Norway
| | | | | | - Simen Vatn
- Department of Gastroenterology, Akershus University Hospital, Lørenskog, Norway
| | | | - Tone B Aabrekk
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Medicine, Vestfold Hospital Trust, Tønsberg, Norway
| | - Trond Espen Detlie
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Gastroenterology, Akershus University Hospital, Lørenskog, Norway
| | - Øistein Hovde
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Medicine, Innlandet Hospital Trust, Gjøvik, Norway
| | | | | | - Magne Henriksen
- Department of Gastroenterology, Østfold Hospital Trust, Sarpsborg, Norway
| | | | - Marte Lie Høivik
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
| | - Lars-Petter Jelsness-Jørgensen
- Department of Gastroenterology, Østfold Hospital Trust, Sarpsborg, Norway
- Department of Health Sciences, Østfold University College, Halden, Norway
| |
Collapse
|
6
|
Minjoz S, Sinniger V, Hot P, Bonaz B, Pellissier S. The burden of early life stress in chronic inflammatory bowel diseases. J Health Psychol 2023; 28:1204-1216. [PMID: 37203800 DOI: 10.1177/13591053231173918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
The aim of this study was to evaluate the prevalence of early life stress (ELS) in a population with inflammatory bowel diseases (IBD) and to estimate its burden on mental, physical, and digestive health. Ninety-three participants with IBD were asked to anonymously complete questionnaires (Childhood Trauma Questionnaire-Short Form, Early Life Event Scale, Perceived Stress Scale, Hospital Anxiety and Depression Scale, Ways of Coping Checklist, Gastro-Intestinal Quality of Life Index questionnaire, and ad hoc questions about symptoms). The prevalence of patients with IBD who were exposed to at least one childhood abuse was 53%. Mental health and quality of life were significantly poorer in patients with IBD who were exposed to early abuse than in those who were not. Patients exposed to ELS had also more digestive perturbations and fatigue. These results suggest that early abuse should be considered a component of IBD care.
Collapse
Affiliation(s)
- Séphora Minjoz
- Université Savoie Mont Blanc, Université Grenoble Alpes, LIP/PC2S, France
- Université Savoie Mont Blanc, Université Grenoble Alpes, LPNC, France
| | - Valérie Sinniger
- Université Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, France
| | - Pascal Hot
- Université Savoie Mont Blanc, Université Grenoble Alpes, LPNC, France
- Institut Universitaire de France, France
| | - Bruno Bonaz
- Université Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, France
| | - Sonia Pellissier
- Université Savoie Mont Blanc, Université Grenoble Alpes, LIP/PC2S, France
| |
Collapse
|
7
|
Uhlir V, Stallmach A, Grunert PC. Fatigue in patients with inflammatory bowel disease-strongly influenced by depression and not identifiable through laboratory testing: a cross-sectional survey study. BMC Gastroenterol 2023; 23:288. [PMID: 37608313 PMCID: PMC10463723 DOI: 10.1186/s12876-023-02906-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 07/25/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Fatigue is a debilitating and highly relevant symptom in patients with inflammatory bowel disease (IBD). However, awareness of fatigue and treatment options remains limited. This study was aimed at elucidating the influence of disease activity and common complications (pain, anemia, depression, anxiety and quality of life) on fatigue in patients with IBD to identify potential interventional targets for treating physicians. METHODS A cross-sectional survey including five questionnaires (HADS, Fatigue Assessment Scale, McGill Pain Questionnaire, IBDQ and general well-being) was performed on patients with IBD (n = 250) at a university IBD clinic. Additionally, demographic data, laboratory data, IBD history, treatment and current disease activity (Harvey-Bradshaw Index, partial Mayo Score, calprotectin and CRP) were recorded. RESULTS A total of 189 patients were analyzed (59.8% with Crohn's disease (CD) and 40.2% with ulcerative colitis (UC)). A total of 51.3% were fatigued, and 12.2% were extremely fatigued. Multiple factors showed significant correlations in univariate analysis. Multivariate analysis revealed that fatigue was correlated with depression (CD, p = 0.002; UC, p = 0.02), diminished quality of life (CD, p = 0.015), female sex (CD, p = 0.015) and younger age (UC, p = 0.024), whereas the influence of anemia or disease activity was non-significant. CONCLUSIONS Fatigue is burdensome and highly prevalent in patients with active and inactive IBD. Considerations for fatigue treatment, beyond targeting inflammation and anemia, should include investigation of underlying sub-clinical depression.
Collapse
Affiliation(s)
- Victoria Uhlir
- Department of Internal Medicine IV, Jena University Hospital, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Andreas Stallmach
- Department of Internal Medicine IV, Jena University Hospital, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Philip Christian Grunert
- Department of Internal Medicine IV, Jena University Hospital, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany.
| |
Collapse
|
8
|
Lee HH, Gweon TG, Kang SG, Jung SH, Lee KM, Kang SB. Assessment of Fatigue and Associated Factors in Patients with Inflammatory Bowel Disease: A Questionnaire-Based Study. J Clin Med 2023; 12:jcm12093116. [PMID: 37176558 PMCID: PMC10179196 DOI: 10.3390/jcm12093116] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/16/2023] [Accepted: 04/23/2023] [Indexed: 05/15/2023] Open
Abstract
Although fatigue is common in patients with inflammatory bowel disease (IBD), it often goes unrecognized and untreated. We investigated the degree of fatigue and associated factors in patients with IBD. A multicenter study involving 147 IBD patients was conducted at five academic hospitals from August 2019 to December 2021. Fatigue was evaluated using the validated Korean version of the Multidimensional Fatigue Inventory (MFI-K). Among 97 ulcerative colitis patients and 50 Crohn's disease patients, the mean total MFI-K score was 59.0 ± 5.5, which corresponded to a moderate-to-severe level of fatigue. Moderate-to-severe disease activity was found to be significantly associated with a higher general and physical fatigue subscale MFI-K score compared to remission-to-mild disease activity (17.6 ± 1.7 vs. 16.7 ± 2.0, p = 0.009), while the use of biologics was associated with a lower total MFI-K score (57.3 ± 5.0 vs. 59.5 ± 5.5, p = 0.031). In multiple linear regression, the total MFI-K score was positively correlated with a history of surgery for IBD, while it was negatively correlated with the use of biologics. Depression was positively correlated with the reduced motivation subscale score. The degree of fatigue in patients with IBD was high. Disease activity, the use of biologics, a history of surgery for IBD, and depression were associated with fatigue.
Collapse
Affiliation(s)
- Han Hee Lee
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Tae-Geun Gweon
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Sung-Goo Kang
- Department of Family Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Republic of Korea
| | - Sung Hoon Jung
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Kang-Moon Lee
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Sang-Bum Kang
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| |
Collapse
|
9
|
Clinical characteristics and quality of life in patients with inflammatory bowel disease-associated anemia in Southeast China. Eur J Gastroenterol Hepatol 2023; 35:275-284. [PMID: 36708298 DOI: 10.1097/meg.0000000000002511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND/AIMS Clinical characteristics of inflammatory bowel disease (IBD) with anemia have not been fully elucidated. This study aimed to investigate the frequency of, risk factors for, and management of anemia in IBD patients and to evaluate the quality of life (QOL) in IBD patients with anemia. METHODS We included two patient cohorts. In cohort 1, clinical data from 697 IBD patients were retrospectively collected. In cohort 2, the Short Form-36 Health Survey (SF-36) and Fatigue Scale-14 (FS-14) questionnaires for IBD patients were completed to evaluate the QOL. RESULTS Anemia was present in 35.6% of IBD patients [38.2% of Crohn's disease (CD) patients vs. 29.3% of ulcerative colitis (UC) patients, P = 0.025]. Elevated platelet (PLT) count (CD: OR, 1.004; 95% CI, 1.001-1.007; P = 0.007; UC: OR, 1.010; 95% CI, 1.004-1.016; P = 0.001), elevated erythrocyte sedimentation rate (ESR) (CD: OR, 1.024; 95% CI, 1.012-1.036; P < 0.001; UC: OR, 1.025; 95% CI, 1.001-1.051; P = 0.044), and lower albumin levels (CD: OR, 0.801; 95% CI, 0.749-0.857; P < 0.001; UC: OR, 0.789; 95% CI, 0.720-0.864; P < 0.001) were associated with anemia. Among the IBD patients with anemia, only 25.8% received treatment for anemia. IBD patients with anemia had significantly lower SF-36 scores (P = 0.011) and higher FS-14 scores (P = 0.026) than those without anemia. CONCLUSION Anemia is common in IBD patients. Elevated PLT count and ESR are risk factors for anemia in IBD patients. Anemia may negatively impact IBD patients' QOL, but few anemia patients receive treatment for anemia.
Collapse
|
10
|
Meng P, Cheng B, Pan C, Liu L, Cheng S, Yang X, Chen Y, Li C, Zhang H, Zhang Z, Zhang J, He D, Shi S, Chu X, Cai Q, Zhang N, Qin X, Zhao Y, Wei W, Jia Y, Wen Y, Zhang F. Evaluating the role of anxiety on the association between irritable bowel syndrome and brain volumes: a mediation analysis in the UK Biobank cohort. Brain Commun 2023; 5:fcad116. [PMID: 37091589 PMCID: PMC10116581 DOI: 10.1093/braincomms/fcad116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 01/24/2023] [Accepted: 04/07/2023] [Indexed: 04/25/2023] Open
Abstract
There is a strong link between irritable bowel syndrome and brain volumes, yet, to date, research examining the mediators of this association has been little. Based on the phenotypic data of 15 248 participants from the UK Biobank, a two-stage mediation analysis was performed to assess the association among brain volumes, anxiety, and irritable bowel syndrome. In the first stage, we identified the candidate mediating role of anxiety for irritable bowel syndrome associated with brain volumes using regression models. Then, we quantified the magnitude of the mediation effects by evaluating the average causal-mediated effect and proportion of mediation through performing mediation analyses in the R package in the second stage. In the first stage, we identified the partly mediating role of anxiety in the association between irritable bowel syndrome and the volume of thalamus (P left = 1.16 × 10-4, P right = 2.41 × 10-4), and grey matter (P left = 3.22 × 10-2, P right = 1.18 × 10-2) in the VIIIa cerebellum. In the second stage, we observed that the proportion of the total effect of irritable bowel syndrome on volume of thalamus mediated by anxiety was 14.3% for the left region (β Average causal-mediated effect = -0.008, P Average causal-mediated effect = 0.004) and 14.6% for the right region (β Average causal-mediated effect = -0.007, P Average causal-mediated effect = 0.006). Anxiety mediated 30.8% for the left region (β Average causal-mediated effect = -0.013, P Average causal-mediated effect = 0.002) and 21.6% for the right region (β Average causal-mediated effect = -0.010, P Average causal-mediated effect x= 0.018) of the total effect of irritable bowel syndrome on the volume of grey matter in the VIIIa cerebellum. Our study revealed the indirect mediating role of anxiety in the association between irritable bowel syndrome and brain volumes, promoting our understanding of the functional mechanisms of irritable bowel syndrome and its related psychosocial factors.
Collapse
Affiliation(s)
| | | | - Chuyu Pan
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi’an Jiaotong University, Xi’an 710061, China
| | - Li Liu
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi’an Jiaotong University, Xi’an 710061, China
| | - Shiqiang Cheng
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi’an Jiaotong University, Xi’an 710061, China
| | - Xuena Yang
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi’an Jiaotong University, Xi’an 710061, China
| | - Yujing Chen
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi’an Jiaotong University, Xi’an 710061, China
| | - Chun’e Li
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi’an Jiaotong University, Xi’an 710061, China
| | - Huijie Zhang
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi’an Jiaotong University, Xi’an 710061, China
| | - Zhen Zhang
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi’an Jiaotong University, Xi’an 710061, China
| | - Jingxi Zhang
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi’an Jiaotong University, Xi’an 710061, China
| | - Dan He
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi’an Jiaotong University, Xi’an 710061, China
| | - Sirong Shi
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi’an Jiaotong University, Xi’an 710061, China
| | - Xiaoge Chu
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi’an Jiaotong University, Xi’an 710061, China
| | - Qingqing Cai
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi’an Jiaotong University, Xi’an 710061, China
| | - Na Zhang
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi’an Jiaotong University, Xi’an 710061, China
| | - Xiaoyue Qin
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi’an Jiaotong University, Xi’an 710061, China
| | - Yijing Zhao
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi’an Jiaotong University, Xi’an 710061, China
| | - Wenming Wei
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi’an Jiaotong University, Xi’an 710061, China
| | - Yumeng Jia
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi’an Jiaotong University, Xi’an 710061, China
| | - Yan Wen
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi’an Jiaotong University, Xi’an 710061, China
| | - Feng Zhang
- Correspondence to: Feng Zhang Key Laboratory of Trace Elements and Endemic Diseases National Health Commission of the People’s Republic of China School of Public Health, Health Science Center Xi’an Jiaotong University, No. 76 Yan Ta West Road, Xi’an 710061, China E-mail:
| |
Collapse
|
11
|
Regueiro M, Hunter T, Lukanova R, Shan M, Wild R, Knight H, Bannikoppa P, Naegeli AN. Burden of Fatigue Among Patients with Ulcerative Colitis and Crohn's Disease: Results from a Global Survey of Patients and Gastroenterologists. Adv Ther 2023; 40:474-488. [PMID: 36370288 PMCID: PMC9898407 DOI: 10.1007/s12325-022-02364-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 10/18/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION To assess the prevalence of fatigue and its association with disease activity and patient-reported outcomes among patients with ulcerative colitis (UC) or Crohn's disease (CD). METHODS Data from a cross-sectional survey conducted with gastroenterologists and their consulting adult patients with UC or CD were analyzed. Data were collected via gastroenterologist-completed patient record forms and patient-self completion forms. Patient demographics, clinical characteristics, disease activity and medication use were reported by the gastroenterologist, while current symptoms (fatigue, rectal urgency, abdominal pain, sleep disturbance), work productivity and the Short Inflammatory Bowel Disease Questionnaire (SIBDQ) were reported by the patient. Logistic regression models were used to identify measures associated with fatigue and expressed as odds ratio (OR) with 95% confidence interval. p < 0.05 was considered statistically significant. RESULTS A total of 1057 patients with UC and 1228 patients with CD were included in this analysis. Fatigue was reported in 22.6% of UC and 26.0% of patients with CD. Higher proportion of patients with UC and fatigue had moderate/severe disease activity (p = 0.0001), had a higher Mayo score (5.0 vs. 4.0, p < 0.0001) and were unemployed (5.6% vs. 3.9%, p = 0.0149) compared to those without fatigue. In patients with CD reporting fatigue, a higher proportion were female (55.9% vs. 48.2%, p = 0.0193), were unemployed (5.8% vs. 4.9%, p = 0.0069), had moderate/severe disease (p < 0.0001) and had a higher mean Crohn's Disease Activity Index score (145.0 vs. 96.2, p < 0.0001) than patients without fatigue. Patients with UC and fatigue had higher mean level of pain (p < 0.0001) and sleep disturbance (p < 0.0001), whereas patients with CD and fatigue had lower SIBDQ scores (p < 0.0001) and greater work impairment (p = 0.0015) than patients without fatigue. Abdominal pain (OR: 2.01, p = 0.001) and use of immunomodulators (OR: 1.69, p = 0.006) increased the odds of having fatigue in patients with UC. In patients with CD, abdominal pain (OR: 2.29, p < 0.001) and use of biologics or biosimilars (OR: 2.02, p = 0.003) increased the odds of having fatigue. CONCLUSION Fatigue is a common symptom among patients with UC or CD that is associated with higher levels of disease activity and decreased work productivity and is driven by various factors. A multidisciplinary approach may be needed to manage fatigue.
Collapse
Affiliation(s)
| | - Theresa Hunter
- Eli Lilly and Company, 893 S. Delaware Street, Indianapolis, IN, 46225, USA.
| | | | - Mingyang Shan
- Eli Lilly and Company, 893 S. Delaware Street, Indianapolis, IN 46225 USA
| | | | | | | | - April N. Naegeli
- Eli Lilly and Company, 893 S. Delaware Street, Indianapolis, IN 46225 USA
| |
Collapse
|
12
|
Salwen-Deremer JK, Sun M. Management of Sleep and Fatigue in Gastrointestinal Patients. Gastroenterol Clin North Am 2022; 51:829-847. [PMID: 36375999 DOI: 10.1016/j.gtc.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Sleep is an essential physiologic process, and unfortunately, people with gastrointestinal (GI) conditions are more likely than people in the general population to experience poor sleep quality, sleep disorders, and fatigue. Herein, we present information on common sleep disorders, fatigue, and data on these problems in various GI populations. We also discuss several treatments for sleep concerns and emerging research on the use of these treatments in GI populations. Cases that illustrate the GI/sleep relationship are presented, in addition to guidance for your own practice and cultural considerations.
Collapse
Affiliation(s)
- Jessica K Salwen-Deremer
- Departments of Psychiatry and Medicine, Section of Gastroenterology & Hepatology, The Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA.
| | - Michael Sun
- Department of Psychological and Brain Sciences, Dartmouth College, 3 Maynard Street, Hanover, NH 03755, USA
| |
Collapse
|
13
|
Kulyk A, Shafer LA, Graff LA, Stone J, Witges K, Targownik LE, Bernstein CN. Urgency for bowel movements is a highly discriminatory symptom of active disease in persons with IBD (the Manitoba Living with IBD study). Aliment Pharmacol Ther 2022; 56:1570-1580. [PMID: 36225106 DOI: 10.1111/apt.17241] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/05/2022] [Accepted: 09/17/2022] [Indexed: 01/30/2023]
Abstract
BACKGROUND The Inflammatory Bowel Disease Symptom Inventory (IBDSI) is a validated patient self-reported measure used to assess IBD disease activity. There have yet to be more granular analyses on which symptoms are most associated with active disease. AIMS To assess the prevalence of symptoms, and to examine which are most associated with disease activity as measured by a symptom index and objective measure of inflammation METHODS: The Manitoba Living with IBD Study is a prospective study of 156 participants with confirmed IBD who completed bi-weekly IBDSI. Relative risks (RR) and predictive values (NPV and PPV) were reported for each symptom to predict active disease defined as active IBDSI, self-reported flare and elevated faecal calprotectin (FCAL) (>250 μg/g). Analyses were undertaken following stratification based on sex, and disease type (Crohn's disease [CD] and ulcerative colitis [UC]). RESULTS In total, 69.2% were female; 64.7% had CD. Fatigue was the most prevalent symptom in both inactive and active disease, across all three disease measures (IBDSI: 24.5% and 75.1%, self-reported flare: 42.2% and 72.2%, FCAL: 46.0% and 60.6%). The absence of fatigue had a high NPV for active IBDSI and self-reporting a flare in both CD and UC. Urgency had a consistently strong NPV and RR across all three disease measures in both IBD subtypes and sexes. The number of loose/liquid bowel movements predicted elevated FCAL in UC (RR males = 3.5, 95% CI 1.2-9.9, RR females = 1.8, 95% CI 1.2-2.7), as did blood in stool in UC females (RR = 1.8, 95% CI 1.2-2.7). In males with CD, excessive bowel gas (RR = 2.0, 95% CI 1.2-3.4) and urgency (RR = 3.9, 95% CI 1.6-9.3) best predicted an elevated FCAL. No symptom was strongly predictive of an elevated FCAL in CD females. CONCLUSIONS Urgency was consistently associated with disease activity, irrespective of the disease measure. Fatigue was the most prevalent symptom irrespective of disease activity measure. Individual symptoms have different impacts on subjective (IBDSI) and objective (FCAL) measures in IBD.
Collapse
Affiliation(s)
- Andrea Kulyk
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,University of Manitoba IBD Clinical and Research Centre, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Leigh Anne Shafer
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,University of Manitoba IBD Clinical and Research Centre, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lesley A Graff
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James Stone
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,University of Manitoba IBD Clinical and Research Centre, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kelcie Witges
- University of Manitoba IBD Clinical and Research Centre, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Laura E Targownik
- University of Manitoba IBD Clinical and Research Centre, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Charles N Bernstein
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,University of Manitoba IBD Clinical and Research Centre, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| |
Collapse
|
14
|
Pekow J. Fatigue in Inflammatory Bowel Disease: A Common Complaint With Few Answers. Gastroenterology 2022; 163:1164-1165. [PMID: 36067822 DOI: 10.1053/j.gastro.2022.08.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 08/29/2022] [Accepted: 08/31/2022] [Indexed: 12/02/2022]
Affiliation(s)
- Joel Pekow
- Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago, Illinois.
| |
Collapse
|
15
|
Proteomic analyses do not reveal subclinical inflammation in fatigued patients with clinically quiescent inflammatory bowel disease. Sci Rep 2022; 12:14581. [PMID: 36028644 PMCID: PMC9418325 DOI: 10.1038/s41598-022-17504-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 07/26/2022] [Indexed: 11/08/2022] Open
Abstract
Fatigue is a common and clinically challenging symptom in patients with inflammatory bowel diseases (IBD), occurring in ~ 50% of patients with quiescent disease. In this study, we aimed to investigate whether fatigue in patients with clinically quiescent IBD is reflected by circulating inflammatory proteins, which might reflect ongoing subclinical inflammation. Ninety-two (92) different inflammation-related proteins were measured in plasma of 350 patients with clinically quiescent IBD. Quiescent IBD was defined as clinical (Harvey-Bradshaw Index < 5 or Simple Clinical Colitis Activity Index < 2.5) and biochemical remission (C-reactive protein < 5 mg/L and absence of anemia) at time of fatigue assessment. Leukemia inhibitory factor receptor (LIF-R) concentrations were inversely associated with severe fatigue, also after adjustment for confounding factors (nominal P < 0.05). Although solely LIF-R showed weak ability to discriminate between mild and severe fatigue (area under the curve [AUC] = 0.61, 95%CI: 0.53–0.69, P < 0.05), a combined set of the top seven (7) fatigue-associated proteins (all P < 0.10) was observed to have reasonable discriminative performance (AUC = 0.82 [95%CI: 0.74–0.91], P < 0.01). Fatigue in patients with IBD is not clearly reflected by distinct protein signatures, suggesting there is no subclinical inflammation defined by the studied inflammatory proteins. Future studies are warranted to investigate other proteomic markers that may reflect fatigue in clinically quiescent IBD.
Collapse
|
16
|
Świątczak M, Młodziński K, Sikorska K, Raczak A, Lipiński P, Daniłowicz-Szymanowicz L. Chronic Fatigue Syndrome in Patients with Deteriorated Iron Metabolism. Diagnostics (Basel) 2022; 12:diagnostics12092057. [PMID: 36140459 PMCID: PMC9498000 DOI: 10.3390/diagnostics12092057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/11/2022] [Accepted: 08/23/2022] [Indexed: 11/16/2022] Open
Abstract
Fatigue is a common, non-specific symptom that often impairs patients’ quality of life. Even though fatigue may be the first symptom of many serious diseases, it is often underestimated due to its non-specific nature. Iron metabolism disorders are a prominent example of conditions where fatigue is a leading symptom. Whether it is an iron deficiency or overload, tiredness is one of the most common features. Despite significant progress in diagnosing and treating iron pathologies, the approach to chronic fatigue syndrome in such patients is not precisely determined. Our study aims to present the current state of knowledge on fatigue in patients with deteriorated iron metabolism.
Collapse
Affiliation(s)
- Michał Świątczak
- II Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Dębinki 7, 80-211 Gdańsk, Poland
| | - Krzysztof Młodziński
- II Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Dębinki 7, 80-211 Gdańsk, Poland
| | - Katarzyna Sikorska
- Department of Tropical Medicine and Epidemiology, Medical University of Gdańsk, Dębinki 7, 80-211 Gdańsk, Poland
| | - Alicja Raczak
- Clinical Psychology Department, Faculty of Health Sciences, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Paweł Lipiński
- Department of Molecular Biology, Institute of Genetics and Animal Breeding, Polish Academy of Sciences, Wólka Kosowska, 05-552 Jastrzębiec, Poland
| | - Ludmiła Daniłowicz-Szymanowicz
- II Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Dębinki 7, 80-211 Gdańsk, Poland
- Correspondence:
| |
Collapse
|
17
|
Falling CL, Siegel CA, Salwen-Deremer JK. Inflammatory Bowel Disease and Pain Interference: A Conceptual Model for the Role of Insomnia, Fatigue, and Pain Catastrophizing. CROHN'S & COLITIS 360 2022; 4:otac028. [PMID: 36777421 PMCID: PMC9802206 DOI: 10.1093/crocol/otac028] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Indexed: 11/12/2022] Open
Abstract
Background People with inflammatory bowel disease (IBD) commonly experience pain influenced by complex interactions among factors, including disease activity, sleep, psychopathology, and changes in pain processing pathways. Treatments for pain in IBD are limited, highlighting the need for research that explores modifiable factors linked to pain. The aim of this study was to investigate relationships among multiple patient factors and to construct a conceptual model for pain interference in IBD. Methods A cross-sectional survey of adults with IBD. Study domains included demographic, comorbidity, psychological, IBD, insomnia, fatigue, and pain features. Structural equation modeling (SEM) was used to examine relationships and interactions among active IBD, insomnia, fatigue, pain experiences (severity, catastrophizing, and interference), and additional patient factors (demographics and psychological). Results One hundred and seventy-four participants, aged 18-85 years, reported the presence of pain. Combining the questionnaire data using SEM resulted in a final model with an excellent fit (χ 2(8) = 9.579, P = .297, χ 2/N = 1.197, CFIN = 0.997, TLI = 0.987, RMSEA = 0.034). The presence of anxiety and depression was the additional patient factors to be retained in the path analysis. SEM results indicated that greater pain interference was directly influenced by greater fatigue, worse pain catastrophizing, and worse pain severity. Pain interference was indirectly impacted by IBD activity, worse insomnia, and the presence of depression and anxiety. Conclusions The proposed conceptual model highlights the role of multiple potentially modifiable factors, including insomnia, pain catastrophizing, and fatigue, contributing to worse pain interference in people with IBD.
Collapse
Affiliation(s)
- Carrie L Falling
- Address correspondence to: Carrie L. Falling, PhD, 325 Great King Street, Dunedin 9016, New Zealand ()
| | - Corey A Siegel
- Department of Medicine, Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Jessica K Salwen-Deremer
- Department of Medicine and Psychiatry, Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| |
Collapse
|
18
|
Xu F, Hu J, Yang Q, Ji Y, Cheng C, Zhu L, Shen H. Prevalence and factors associated with fatigue in patients with ulcerative colitis in China: a cross-sectional study. BMC Gastroenterol 2022; 22:281. [PMID: 35659567 PMCID: PMC9163521 DOI: 10.1186/s12876-022-02357-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 05/24/2022] [Indexed: 11/21/2022] Open
Abstract
Background Fatigue is one of the most common symptoms reported by patients with ulcerative colitis (UC), while it has not been fully recognized and taken seriously in clinical practice. We aimed to investigate the prevalence of fatigue in patients with UC and identify the factors associated with fatigue and its severity in China. Methods A cross-sectional study was conducted in Affiliated Hospital of Nanjing University of Chinese Medicine from May 2020 to February 2021. Demographic and clinical characteristics were collected. Fatigue was evaluated with the Fatigue Severity Scale and the Multidimensional Fatigue Inventory. The Hospital Anxiety and Depression Scale, the Pittsburgh Sleep Index Scale and the Malnutrition Universal Screening Tool were respectively used to evaluate the anxiety, depression, sleep disturbance and nutritional risk of patients with UC. Results A total of 220 UC patients were enrolled in this study. The prevalence of fatigue in patients was 61.8%, of which in patients with disease activity was 68.2%, and in patients in remission was 40.0%. Univariate analysis indicated that the Montreal classification, disease activity, anemia, anxiety, depression, sleep disturbance and high nutritional risk were the factors associated with fatigue in Patients with UC. Multivariate logistic regression analysis showed that the Montreal classification (E3: E1, OR = 2.665, 95% CI = 1.134–6.216), disease activity (OR = 2.157, 95% CI = 1.055–4.410) and anxiety (OR = 2.867, 95% CI = 1.154–7.126) were related to an increased risk of fatigue. Disease activity (RC = 0.240, 95% CI = 0.193–0.674) and anxiety (RC = 0.181, 95% CI = 0.000–0.151) were associated with severity of fatigue. Conclusions This study demonstrated that the prevalence of fatigue among UC patients in China. The Montreal classification, disease activity and anxiety are associated with an increased risk of fatigue.
Collapse
|
19
|
Walentynowicz M, van de Pavert I, Fierens L, Coenen S, Vlaeyen JWS, von Leupoldt A, Van Oudenhove L, Vermeire S, Van Assche G, Ferrante M, Van Diest I. Inflammatory Bowel Disease-related Behaviours [IBD-Bx] Questionnaire: Development, Validation and Prospective Associations with Fatigue. J Crohns Colitis 2022; 16:581-590. [PMID: 34622275 DOI: 10.1093/ecco-jcc/jjab174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Disease-related behaviours that may maintain or worsen symptom burden remain largely unexplored in inflammatory bowel disease [IBD]. In this study, we developed and validated an instrument assessing IBD-related, modifiable behaviours and explored which behaviours prospectively correlate with fatigue, a debilitating and common symptom in IBD. METHODS Initially, 72 items reflecting IBD-related behaviours were generated based on literature review and input from clinicians and people diagnosed with IBD. During wave 1, 495 IBD patients rated to what extent each behaviour was applicable to them. Additionally, disease activity, fatigue, IBD-related concerns and psychological variables were assessed. During a follow-up visit 4-12 weeks later [wave 2], a random selection of 92 patients from wave 1 completed the measures assessing the IBD-related behaviours, disease activity and fatigue once more. RESULTS A principal component analysis with oblique rotation revealed seven components in the 72 IBD behaviours, which could be interpreted as: [1] Avoiding food and activities, [2] Access to toilets, [3] Avoidance of sex, [4] Cognitive avoidance, [5] Not sharing with others, [6] Alternative treatments and [7] Disease management. Each component was reduced to three to five representative items, resulting in a final, 25-item IBD-Bx questionnaire showing good concurrent validity [alphas > 0.63] and reliability. Almost all components were cross-sectionally related to levels of fatigue. Avoiding food and activities and Access to toilets significantly predicted fatigue at wave 2 when controlling for baseline fatigue. CONCLUSIONS The IBD-Bx is a valid and reliable questionnaire of IBD-related behaviours, some of which predict future fatigue burden.
Collapse
Affiliation(s)
- Marta Walentynowicz
- Centre for the Psychology of Learning and Experimental Psychopathology, KU Leuven, Leuven, Belgium.,Psychological Science Research Institute, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | | | - Liselotte Fierens
- Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium
| | - Sofie Coenen
- Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium.,Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Johan W S Vlaeyen
- Health Psychology Research Group, KU Leuven, Leuven, Belgium.,Experimental Health Psychology, Department of Clinical Psychological Science, Maastricht University, Netherlands
| | | | - Lukas Van Oudenhove
- Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium.,Cognitive and Affective Neuroscience Lab, Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, USA
| | - Séverine Vermeire
- Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium.,Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Gert Van Assche
- Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium.,Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Marc Ferrante
- Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium.,Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Ilse Van Diest
- Health Psychology Research Group, KU Leuven, Leuven, Belgium
| |
Collapse
|
20
|
Grimstad T, Skjellerudsveen BM, Kvaløy JT, Skoie IM, Carlsen A, Karlsen LN, Aabakken L, Omdal R. The influence of disease activity on fatigue in patients with ulcerative colitis - a longitudinal study. Scand J Gastroenterol 2022; 57:290-297. [PMID: 34846950 DOI: 10.1080/00365521.2021.2007281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The relationship between the disease activity of ulcerative colitis and fatigue is unclear. We investigated how reaching deep remission versus remaining in active disease influenced the severity of fatigue. MATERIALS AND METHODS We included 149 consecutive patients in a longitudinal study. Patients were re-examined after 3 months of conventional treatment and dichotomized into A: Active disease or B: Deep remission. The Partial Mayo Score (PMS) was recorded in all patients. Fatigue was rated using the fatigue visual analog scale (fVAS), Fatigue Severity Scale (FSS), and Short Form-36 Vitality Subscale (SF-36vs). A control group of 22 age and sex-matched healthy subjects were included as controls for patients reaching deep remission. RESULTS After 3 months there were no significant differences in fVAS, FSS and SF-36vs scores in patients with active disease compared to patients reaching deep remission, when adjusting for baseline fatigue scores. Patients in remission based on MES-UC scores had no significant reduction in fatigue scores, whereas patients in remission based on PMS had all three fatigue scores reduced. However, patients reaching deep remission still had higher fVAS and lower SF-36vs scores compared to healthy control subjects. CONCLUSIONS After 3 months of conventional treatment there were no differences in fatigue severity in patients reaching deep remission compared with patients still having active disease. Fatigue was more pronounced in patients in deep remission than in healthy subjects, and was associated with subjective and not objective measures of disease activity. This indicates that other potent factors than inflammation influence fatigue in UC.
Collapse
Affiliation(s)
- Tore Grimstad
- Department of Internal Medicine, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | | | - Jan Terje Kvaløy
- Department of Mathematics and Natural Science, University of Stavanger, Stavanger, Norway.,Department of Research, Stavanger University, Stavanger, Norway
| | | | - Arne Carlsen
- Department of Internal Medicine, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Lars N Karlsen
- Department of Internal Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Lars Aabakken
- Department of Medicine, Oslo University Hospital, Rikshospitalet, Norway
| | - Roald Omdal
- Department of Internal Medicine, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| |
Collapse
|
21
|
Klusmann B, Fleer J, Tovote KA, Weersma RK, van Dullemen HM, Dijkstra G, Schroevers MJ. Trajectories of Fatigue in Inflammatory Bowel Disease. Inflamm Bowel Dis 2021; 27:1919-1930. [PMID: 33769489 DOI: 10.1093/ibd/izab007] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Fatigue is one of the most frequently reported symptoms by patients with inflammatory bowel disease (IBD), both during active disease phases as well as during clinical remission. This study addressed whether different trajectories of fatigue over time can be identified among patients with IBD. Subsequently, we compared the demographic and clinical characteristics between trajectories. METHODS The current study included 849 patients with IBD diagnosed with either Crohn disease (CD; n = 511) or ulcerative colitis (UC; n = 338) who visited the University Medical Center in Groningen (the Netherlands) at least 3 times during a 9-year follow-up. We conducted latent class growth analyses to identify distinct trajectories. RESULTS In all patients with IBD (and in the subgroup with CD), we found 5 trajectories for fatigue. In the UC subgroup, we found 4 fatigue trajectories. One trajectory present in both patients with CD (11.45%) and patients with UC (4.75%) was characterized by chronic elevated levels of fatigue across time. Women and parents were more prevalent in trajectories with higher fatigue severity. We also found significant associations among the fatigue trajectories with disease activity and psychological well-being. CONCLUSIONS The results clearly showed the existence of distinct fatigue paths over time in patients with IBD. Those reporting more chronic elevated levels of fatigue also reported greater disease activity and reduced well-being. Therefore, reducing disease activity may be important for the treatment of fatigue. In addition, given the significant association with well-being, it is possible that reducing fatigue may improve self-reported well-being.
Collapse
Affiliation(s)
- Birte Klusmann
- Department of Health Sciences, University of Groningen and University Medical Center, Groningen, the Netherlands
| | - Joke Fleer
- Department of Health Sciences, University of Groningen and University Medical Center, Groningen, the Netherlands
| | - K Annika Tovote
- Department of Health Sciences, University of Groningen and University Medical Center, Groningen, the Netherlands
| | - Rinse K Weersma
- Department of Gastroenterology and Hepatology, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands
| | - Hendrik M van Dullemen
- Department of Gastroenterology and Hepatology, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands
| | - Gerard Dijkstra
- Department of Gastroenterology and Hepatology, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands
| | - Maya J Schroevers
- Department of Health Sciences, University of Groningen and University Medical Center, Groningen, the Netherlands
| |
Collapse
|
22
|
Heaney A, McKenna SP, Hagell P. Evaluation of the Unidimensional Fatigue Impact Scale (U-FIS) in Crohn's Disease: The Importance of Local Item Dependency. J Nurs Meas 2021; 30:JNM-D-20-00116. [PMID: 34518414 DOI: 10.1891/jnm-d-20-00116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE The Unidimensional Fatigue Impact Scale (U-FIS) was developed for use in a multiple sclerosis population. The aim was to determine whether the U-FIS is a valid tool for measuring the impact of fatigue in Crohn's disease (CD). METHOD CD patients completed the U-FIS as part of a validation study of the Crohn's Life Impact Questionnaire (CLIQ). Data were analyzed according to Rasch measurement theory (RMT). RESULTS Two hundred sixty-one completed U-FIS questionnaires were available for analysis. After rescoring the items to resolve disordered thresholds, all 22 items showed acceptable RMT fit. However, there was considerable local item dependency (LID). CONCLUSION The U-FIS did not provide unidimensional measurement in a sample of CD patients due to high levels of LID. Combining the three FIS outcomes into a single measure was not justified.
Collapse
Affiliation(s)
| | - Stephen P McKenna
- Galen Research Ltd, Manchester, UK; University of Manchester, Manchester, UK
| | | |
Collapse
|
23
|
Emerson C, Barhoun P, Olive L, Fuller-Tyszkiewicz M, Gibson PR, Skvarc D, Mikocka-Walus A. A systematic review of psychological treatments to manage fatigue in patients with inflammatory bowel disease. J Psychosom Res 2021; 147:110524. [PMID: 34034138 DOI: 10.1016/j.jpsychores.2021.110524] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 03/01/2021] [Accepted: 05/17/2021] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Fatigue is highly prevalent, debilitating and associated with poor mental health in people with inflammatory bowel disease (IBD). However, little is known about the efficacy of psychological interventions to manage IBD fatigue. This systematic review aimed to establish the efficacy of psychological interventions to manage IBD fatigue. METHODS Studies were identified by systematically searching MEDLINE, PsychINFO, CINAHL, EMBASE, Cochrane CENTRAL, Google Scholar and Open Grey. Included studies needed to employ a randomised control trial (RCT) design with a psychological intervention targeted at reducing fatigue in patients with IBD and include a measure of fatigue. All screening, as well as data extraction and quality appraisals, were conducted by two researchers independently. RESULTS Four RCTs were included in this systematic review. Psychological interventions including psychoeducation, cognitive behaviour therapy and solution-based approach showed preliminary efficacy for fatigue, however the studies were small and largely underpowered. CBT was the most efficacious psychotherapy trialled, with a greater reduction in fatigue severity (g = 0.91, CI 95% [- 0.30, 2.11]) and impact (g = 0.87, CI 95% [- 0.22, 2.07]) seen in the intervention group between baseline and 12-months follow-up when compared to the control group using the IBD-F scale. However, while these effect sizes are strong, they were non-significant due to being underpowered. CONCLUSION While the evidence is scant and low quality, psychological interventions show promise in improving IBD fatigue. Future studies should examine larger samples and employ longer follow-up to better determine efficacy of psychological interventions for fatigue in people with IBD.
Collapse
Affiliation(s)
- Catherine Emerson
- School of Psychology, Faculty of Health, Deakin University, Geelong, Victoria, Australia.
| | - Pamela Barhoun
- School of Psychology, Faculty of Health, Deakin University, Geelong, Victoria, Australia.
| | - Lisa Olive
- School of Psychology, Faculty of Health, Deakin University, Geelong, Victoria, Australia.
| | | | - Peter R Gibson
- Department of Gastroenterology, Monash University and Alfred Health, Melbourne, Victoria, Australia.
| | - David Skvarc
- School of Psychology, Faculty of Health, Deakin University, Geelong, Victoria, Australia.
| | - Antonina Mikocka-Walus
- School of Psychology, Faculty of Health, Deakin University, Geelong, Victoria, Australia.
| |
Collapse
|
24
|
Mental Health Factors Associated With Fatigue in Mexican Patients With Inflammatory Bowel Disease. J Clin Gastroenterol 2021; 55:609-614. [PMID: 32675632 DOI: 10.1097/mcg.0000000000001397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 06/14/2020] [Indexed: 12/10/2022]
Abstract
GOALS The aim of this study was to describe mental health factors associated with the development of fatigue in inflammatory bowel disease (IBD) patients. BACKGROUND IBD includes ulcerative colitis and Crohn's disease. Patients with chronic diseases can present fatigue differently and qualitatively more severely than those typically represented by healthy populations. STUDY This was a cross-sectional study in which 200 Mexican patients were attending the Inflammatory Bowel Disease Clinic at the National Institute of Medical Sciences and Nutrition. All patients answered 3 instruments: the first IBD-fatigue, HADS (Hospital Anxiety and Depression Scale), and PSQI (Pittsburgh Sleep Quality Index). The statistical analysis was carried out in the statistical program SPSS v 24. RESULTS The percentage of fatigue in our patients was 55.5% (n=111) for mild-moderate fatigue, 31.5% (n=63) for severe fatigue, and only 13% (n=26) had no fatigue. Sleep disturbance and sleep latency were the most important predictors of fatigue in IBD patients. CONCLUSIONS Sleep quality and depression have an impact on fatigue in Mexican patients with IBD. It is important for multidisciplinary management to reduce these symptoms and improve the quality of life of patients with IBD.
Collapse
|
25
|
McGing JJ, Radford SJ, Francis ST, Serres S, Greenhaff PL, Moran GW. Review article: The aetiology of fatigue in inflammatory bowel disease and potential therapeutic management strategies. Aliment Pharmacol Ther 2021; 54:368-387. [PMID: 34228817 DOI: 10.1111/apt.16465] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 09/30/2020] [Accepted: 05/20/2021] [Indexed: 12/13/2022]
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.
Collapse
Affiliation(s)
- Jordan J McGing
- School of Medicine, University of Nottingham, Nottingham, UK.,Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, UK
| | - Shellie Jean Radford
- School of Medicine, University of Nottingham, Nottingham, UK.,National Institute of Health Research Nottingham Biomedical Research Centre (NIHR), Nottingham University Hospitals and University of Nottingham, Nottingham, UK
| | - Susan T Francis
- Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, UK.,National Institute of Health Research Nottingham Biomedical Research Centre (NIHR), Nottingham University Hospitals and University of Nottingham, Nottingham, UK
| | - Sébastien Serres
- School of Life Sciences, University of Nottingham, Nottingham, UK
| | - Paul L Greenhaff
- National Institute of Health Research Nottingham Biomedical Research Centre (NIHR), Nottingham University Hospitals and University of Nottingham, Nottingham, UK.,MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, National Institute for Health Research (NIHR), Nottingham Biomedical Research Centre, School of Life Sciences, University of Nottingham, Nottingham, UK
| | - Gordon W Moran
- School of Medicine, University of Nottingham, Nottingham, UK.,National Institute of Health Research Nottingham Biomedical Research Centre (NIHR), Nottingham University Hospitals and University of Nottingham, Nottingham, UK
| |
Collapse
|
26
|
Rhodes KA, Walker JT, Zhang L, Carr KL, Winters KP, Glover SC. The Impact of Transition Readiness and Stress on Patient-Centered Outcomes in Young Adults With Inflammatory Bowel Disease. Gastroenterol Nurs 2021; 44:259-267. [PMID: 34238884 DOI: 10.1097/sga.0000000000000555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 08/08/2020] [Indexed: 12/13/2022] Open
Abstract
Young adults, 18-35 years of age, account for nearly half of all inflammatory bowel disease emergency department visits annually, costing millions of healthcare dollars and signifying undue pain and suffering. To mitigate this sequela, the study aimed to characterize the relationships between transition readiness (self-management ability), stress, and patient-centered outcomes. Outcomes were defined as disease activity and inflammatory bowel disease-related healthcare utilization (emergency department visits and inpatient hospitalization). This was a descriptive, correlational design via online survey of young adults with inflammatory bowel disease. Participants (n = 284) utilized an estimated 2.77 million healthcare dollars in 12 months. Transition readiness decreased the odds of having consistently active disease and healthcare utilization, with adjusted odds ratio ranging from 6.4 to 10.9 (p < .05). Higher stress levels increased the odds of having consistently active disease and healthcare utilization, with adjusted odds ratio ranging from 9.5 to 10.5 (p < .0001). Twenty-five percent (24.7%) of the variation in transition readiness was explained by changes in stress (p < .0001). Transition readiness and stress impacted all patient-centered outcomes. Stress negatively impacted transition readiness. These results are powerful reminders for healthcare providers to assess and treat stress and support transition readiness in young adults with inflammatory bowel disease. The potential to decrease pain, suffering, and healthcare cost is enormous.
Collapse
Affiliation(s)
- Kathleen A Rhodes
- Kathleen A. Rhodes, PhD, RN, FNP-C, is Assistant Professor, University of Mississippi Medical Center School of Nursing, Jackson
- Jean T. Walker, PhD, RN, is Professor, University of Mississippi Medical Center School of Nursing, Jackson
- Lei Zhang, PhD, MBA, is Professor, University of Mississippi Medical Center School of Nursing and Director, Mississippi State Department of Health, Office of Health Data & Research, Jackson
- Kayla L. Carr, PhD, RN, FNP-C, is Assistant Professor, University of Mississippi Medical Center School of Nursing, Jackson
- Karen P. Winters, PhD, RN, is Professor, University of Mississippi Medical Center School of Nursing, Jackson
- Sarah C. Glover, DO, AGAF, is Professor, Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson
| | - Jean T Walker
- Kathleen A. Rhodes, PhD, RN, FNP-C, is Assistant Professor, University of Mississippi Medical Center School of Nursing, Jackson
- Jean T. Walker, PhD, RN, is Professor, University of Mississippi Medical Center School of Nursing, Jackson
- Lei Zhang, PhD, MBA, is Professor, University of Mississippi Medical Center School of Nursing and Director, Mississippi State Department of Health, Office of Health Data & Research, Jackson
- Kayla L. Carr, PhD, RN, FNP-C, is Assistant Professor, University of Mississippi Medical Center School of Nursing, Jackson
- Karen P. Winters, PhD, RN, is Professor, University of Mississippi Medical Center School of Nursing, Jackson
- Sarah C. Glover, DO, AGAF, is Professor, Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson
| | - Lei Zhang
- Kathleen A. Rhodes, PhD, RN, FNP-C, is Assistant Professor, University of Mississippi Medical Center School of Nursing, Jackson
- Jean T. Walker, PhD, RN, is Professor, University of Mississippi Medical Center School of Nursing, Jackson
- Lei Zhang, PhD, MBA, is Professor, University of Mississippi Medical Center School of Nursing and Director, Mississippi State Department of Health, Office of Health Data & Research, Jackson
- Kayla L. Carr, PhD, RN, FNP-C, is Assistant Professor, University of Mississippi Medical Center School of Nursing, Jackson
- Karen P. Winters, PhD, RN, is Professor, University of Mississippi Medical Center School of Nursing, Jackson
- Sarah C. Glover, DO, AGAF, is Professor, Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson
| | - Kayla L Carr
- Kathleen A. Rhodes, PhD, RN, FNP-C, is Assistant Professor, University of Mississippi Medical Center School of Nursing, Jackson
- Jean T. Walker, PhD, RN, is Professor, University of Mississippi Medical Center School of Nursing, Jackson
- Lei Zhang, PhD, MBA, is Professor, University of Mississippi Medical Center School of Nursing and Director, Mississippi State Department of Health, Office of Health Data & Research, Jackson
- Kayla L. Carr, PhD, RN, FNP-C, is Assistant Professor, University of Mississippi Medical Center School of Nursing, Jackson
- Karen P. Winters, PhD, RN, is Professor, University of Mississippi Medical Center School of Nursing, Jackson
- Sarah C. Glover, DO, AGAF, is Professor, Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson
| | - Karen P Winters
- Kathleen A. Rhodes, PhD, RN, FNP-C, is Assistant Professor, University of Mississippi Medical Center School of Nursing, Jackson
- Jean T. Walker, PhD, RN, is Professor, University of Mississippi Medical Center School of Nursing, Jackson
- Lei Zhang, PhD, MBA, is Professor, University of Mississippi Medical Center School of Nursing and Director, Mississippi State Department of Health, Office of Health Data & Research, Jackson
- Kayla L. Carr, PhD, RN, FNP-C, is Assistant Professor, University of Mississippi Medical Center School of Nursing, Jackson
- Karen P. Winters, PhD, RN, is Professor, University of Mississippi Medical Center School of Nursing, Jackson
- Sarah C. Glover, DO, AGAF, is Professor, Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson
| | - Sarah C Glover
- Kathleen A. Rhodes, PhD, RN, FNP-C, is Assistant Professor, University of Mississippi Medical Center School of Nursing, Jackson
- Jean T. Walker, PhD, RN, is Professor, University of Mississippi Medical Center School of Nursing, Jackson
- Lei Zhang, PhD, MBA, is Professor, University of Mississippi Medical Center School of Nursing and Director, Mississippi State Department of Health, Office of Health Data & Research, Jackson
- Kayla L. Carr, PhD, RN, FNP-C, is Assistant Professor, University of Mississippi Medical Center School of Nursing, Jackson
- Karen P. Winters, PhD, RN, is Professor, University of Mississippi Medical Center School of Nursing, Jackson
- Sarah C. Glover, DO, AGAF, is Professor, Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson
| |
Collapse
|
27
|
Varbobitis I, Kokkotis G, Gizis M, Perlepe N, Laoudi E, Bletsa M, Bekiari D, Koutsounas I, Kounadis G, Xourafas V, Lagou S, Kolios G, Papakonstantinou I, Bamias G. The IBD-F Patient Self-Assessment Scale Accurately Depicts the Level of Fatigue and Predicts a Negative Effect on the Quality of Life of Patients With IBD in Clinical Remission. Inflamm Bowel Dis 2021; 27:826-835. [PMID: 32766770 DOI: 10.1093/ibd/izaa201] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Fatigue is highly prevalent among patients with inflammatory bowel disease (IBD) and may have an unfavorable impact on quality of life (QoL). The IBD-Fatigue scale (with components SCORE1 and SCORE2) is a recently developed disease-specific questionnaire. We sought to validate a Greek version of IBD-F and use it to assess the severity and characteristics of fatigue and its effect on QoL in our study population. METHODS The IBD-F scale was validated and used to obtain fatigue-related data from patients with IBD attending a tertiary care hospital. Correlations with other fatigue and QoL instruments were performed. RESULTS The Greek IBD-F showed high internal consistency and test-retest reliability (Cronbach's alpha = 0.901/0.966 and intraclass correlation coefficient = 0.876/0.895 for SCORE1/SCORE2, respectively). A SCORE1 >7.5 suggested "significant" fatigue. In a cohort of 157 patients (mean age = 35.8 y; male patients = 52.2%; patients with Crohn disease = 65.6%), both SCORE1 and SCORE2 were significantly associated with Crohn disease (odds ratio [OR] = 4.17; 95% confidence interval [CI], 2.05-8.47; b = 8.5; 95% CI, 2.8-14.1, respectively), female sex (OR = 7.27; 95% CI, 3.19-16.6; b = 15.3; 95% CI, 9-21.6), and Harvey-Bradshaw Index/Simple Clinical Colitis Activity Index score (OR = 1.22; 95% CI, 1.06-1.39; b = 1.8; 95% CI, 0.9-2.8). A SCORE1 >7.5 was present in 46% of patients in remission, and 82% of patients with a baseline SCORE1 >7.5 remained fatigued at serial measurements. The SCORE1 was significantly associated with impaired QoL (P < 0.001). CONCLUSIONS The validated IBD-F scale is a useful and applicable instrument for use in the IBD population. A large proportion of patients have significant fatigue, which is maintained longitudinally, independent of inflammatory activity. Fatigue impairs QoL, thus necessitating interventions that may lead to its amelioration in the IBD population.
Collapse
Affiliation(s)
- Ioannis Varbobitis
- Department of Gastroenterology, Nottingham Digestive Diseases Centre, Nottingham University Hospitals NHS, Nottingham, UK
| | - Georgios Kokkotis
- GI Unit, 3rd Department of Internal Medicine, National & Kapodistrian University of Athens, Sotiria Hospital, Athens, Greece
| | - Michael Gizis
- GI Unit, 3rd Department of Internal Medicine, National & Kapodistrian University of Athens, Sotiria Hospital, Athens, Greece
| | - Nikoletta Perlepe
- GI Unit, 3rd Department of Internal Medicine, National & Kapodistrian University of Athens, Sotiria Hospital, Athens, Greece
| | - Efrosini Laoudi
- GI Unit, 3rd Department of Internal Medicine, National & Kapodistrian University of Athens, Sotiria Hospital, Athens, Greece
| | - Maria Bletsa
- GI Unit, 3rd Department of Internal Medicine, National & Kapodistrian University of Athens, Sotiria Hospital, Athens, Greece
| | - Despoina Bekiari
- GI Unit, 3rd Department of Internal Medicine, National & Kapodistrian University of Athens, Sotiria Hospital, Athens, Greece
| | - Ioannis Koutsounas
- GI Unit, 3rd Department of Internal Medicine, National & Kapodistrian University of Athens, Sotiria Hospital, Athens, Greece
| | - Georgios Kounadis
- GI Unit, 3rd Department of Internal Medicine, National & Kapodistrian University of Athens, Sotiria Hospital, Athens, Greece
| | - Vassileios Xourafas
- GI Unit, 3rd Department of Internal Medicine, National & Kapodistrian University of Athens, Sotiria Hospital, Athens, Greece
| | - Stilliani Lagou
- GI Unit, 3rd Department of Internal Medicine, National & Kapodistrian University of Athens, Sotiria Hospital, Athens, Greece
| | - George Kolios
- Laboratory of Pharmacology, Faculty of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Ioannis Papakonstantinou
- Second Department of Surgery, National and Kapodistrian University of Athens, Medical School, Aretaieion University Hospital, Athens, Greece
| | - Giorgos Bamias
- GI Unit, 3rd Department of Internal Medicine, National & Kapodistrian University of Athens, Sotiria Hospital, Athens, Greece
| |
Collapse
|
28
|
Qazi T, Smith A, Alexander M, Hammer D, Wu T, Auerbach S, Noronha A, Wasan S, Jones E, Weinberg J, Farraye FA. Disparities in Objective Sleep Quality as Assessed Through Wrist Actigraphy in Minority Patients With Inflammatory Bowel Disease. Inflamm Bowel Dis 2021; 27:371-378. [PMID: 32448906 DOI: 10.1093/ibd/izaa106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Indexed: 12/09/2022]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) is associated with a reduced quality of life. Minority patients with IBD specifically report more impairing symptoms compared with nonminority patients. Sleep quality, a key component of quality of life, is significantly compromised in minority patients compared with nonminority patients. Nevertheless, subjective and objective sleep assessments in minority patients with IBD have not explicitly been assessed. The purpose of this prospective cohort study is to assess and compare objective sleep parameters utilizing wrist actigraphy between minority and nonminority IBD patients. METHODS In this institutional review board approved study, 74 patients with IBD were recruited and stratified into 2 cohorts by self-identification: white nonminority patients and minority patients. Patients in the minority cohort included black and Hispanic individuals (black and nonblack). Exclusion criteria included significant comorbidity, a history of an underlying sleep disorder, or patients who did not self-identify into categorized cohorts. Sleep was measured not only through wrist-based actigraphy but also with sleep surveys. Sleep parameters were compared between minority and nonminority cohorts. Regression analyses were performed to assess for factors independently associated with parameters of poor sleep quality. RESULTS Sixty-four patients (86.4%) were included in the final analysis. Thirty-one individuals (48.4%) were categorized into the nonminority cohort, and 33 (51.6%) patients were in the minority cohort. A significantly higher number of minority patients had poorer sleep efficiency and fragmented sleep compared with nonminority patients (90.9% vs 67.7%; P = 0.03 and 87.8% vs 61.3%; P = 0.02). In the adjusted analysis, minority status was independently associated with poor sleep efficiency (odds ratio = 6.41; 95% confidence interval, 1.48-28.17; P = 0.0139) and fragmented sleep (odds ratio = 4.98; 95% confidence interval, 1.09-22.89; P = 0.0389). CONCLUSIONS Minority patients with IBD were shown to have poorer objective measures of sleep as assessed through wrist actigraphy compared to nonminority patients. Cultural competency in the care of minority patients with IBD, specifically focusing on the management of psychosocial issues, is needed to address these disparities in sleep. The inclusion of minority patients with IBD in studies investigating sleep and other psychosocial issues are warranted not only to assess potential disparities in disease course but also to determine the etiologies of poor sleep in minority patients with IBD.
Collapse
Affiliation(s)
- Taha Qazi
- Cleveland Clinic, Digestive Disease and Surgery Institute, Cleveland, Ohio, USA
| | - Alexander Smith
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Megan Alexander
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - David Hammer
- Department of Neurology, Boston University School of Medicine and Sleep Disorders Center, Boston Medical Center, Boston, Massachusetts, USA
| | - Ting Wu
- Department of Neurology, Boston University School of Medicine and Sleep Disorders Center, Boston Medical Center, Boston, Massachusetts, USA
| | - Sanford Auerbach
- Department of Neurology, Boston University School of Medicine and Sleep Disorders Center, Boston Medical Center, Boston, Massachusetts, USA
| | - Ansu Noronha
- Section of Gastroenterology, Boston Medical Center, Boston, Massachusetts, USA
| | - Sharmeel Wasan
- Section of Gastroenterology, Boston Medical Center, Boston, Massachusetts, USA
| | - Eric Jones
- Boston University School of Public Health, Department of Biostatistics, Boston, Massachusetts, USA
| | - Janice Weinberg
- Boston University School of Public Health, Department of Biostatistics, Boston, Massachusetts, USA
| | - Francis A Farraye
- Section of Gastroenterology, Boston Medical Center, Boston, Massachusetts, USA.,Department of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| |
Collapse
|
29
|
Borren NZ, Long MD, Sandler RS, Ananthakrishnan AN. Longitudinal Trajectory of Fatigue in Patients With Inflammatory Bowel Disease: A Prospective Study. Inflamm Bowel Dis 2020; 27:1740-1746. [PMID: 33367749 PMCID: PMC8528141 DOI: 10.1093/ibd/izaa338] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND Fatigue is a disabling symptom in patients with inflammatory bowel disease (IBD). Its prevalence, mechanism, and impact remain poorly understood. We determined changes in fatigue status over time and identified predictors of incident or resolving fatigue. METHODS This was a prospective study nested within the IBD Partners cohort. Participants prospectively completed the Multidimensional Fatigue Inventory and the Functional Assessment of Chronic Illness Therapy-Fatigue at baseline, 6 months, and 12 months. A Functional Assessment of Chronic Illness Therapy-Fatigue score ≤43 defined significant fatigue. Multivariable regression models using baseline covariates were used to identify risk factors for incident fatigue at 6 months and to predict the resolution of fatigue. RESULTS A total of 2429 patients (1605 with Crohn disease, 824 with ulcerative colitis) completed a baseline assessment, and 1057 completed a second assessment at 6 months. Persistent fatigue (at baseline and at 6 months) was the most common pattern, affecting two-thirds (65.8%) of patients. One-sixth (15.7%) of patients had fatigue at 1 timepoint, whereas fewer than one-fifth (18.5%) of patients never reported fatigue. Among patients not fatigued at baseline, 26% developed fatigue at 6 months. The strongest predictor of incident fatigue was sleep disturbance at baseline (odds ratio, 2.91; 95% confidence interval, 1.48-5.72). In contrast, only 12.3% of those with fatigue at baseline had symptom resolution by month 6. Resolution was more likely in patients with a diagnosis of ulcerative colitis, quiescent disease, and an absence of significant psychological comorbidity. CONCLUSIONS Fatigue is common in patients with IBD. However, only a few fatigued patients experience symptom resolution at 6 or 12 months, suggesting the need for novel interventions to ameliorate its impact.
Collapse
Affiliation(s)
- Nienke Z Borren
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA,Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Millie D Long
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Robert S Sandler
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Ashwin N Ananthakrishnan
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA,Harvard Medical School, Boston, Massachusetts, USA,Address correspondence to: Ashwin N. Ananthakrishnan, MD, MPH, Crohn’s and Colitis Center, Massachusetts General Hospital, 165 Cambridge Street, 9th Floor, Boston, MA 02114 ()
| |
Collapse
|
30
|
Horta D, Moreno-Torres M, Ramírez-Lázaro MJ, Lario S, Kuligowski J, Sanjuan-Herráez JD, Quintas G, Villoria A, Calvet X. Analysis of the Association between Fatigue and the Plasma Lipidomic Profile of Inflammatory Bowel Disease Patients. J Proteome Res 2020; 20:381-392. [PMID: 32969224 DOI: 10.1021/acs.jproteome.0c00462] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Inflammatory bowel disease (IBD) is a chronic, relapsing noninfectious inflammatory condition of the intestinal tract with two main phenotypes, ulcerative colitis (UC) and Crohn's disease (CD), and globally increasing incidence and prevalence. Nearly 80% of the IBD patients with active disease and 50% of those with inactive disease suffer fatigue with significant impairment of their quality of life. Fatigue has been associated with multiple factors in IBD patients but, in most cases, no direct cause can be identified, and risk factors in clinically quiescent IBD are contradictory. Furthermore, as the assessment of fatigue is subjective, there is an unmet clinical need for fatigue biomarkers. In this explorative study, we analyzed the plasma lipidomic profiles of 47 quiescent UC and CD patients (23 fatigued, 24 nonfatigued) using ultraperformance liquid chromatography-time-of-flight mass spectrometry (UPLC-TOFMS). The results showed changes in lipids associated with fatigue and IBD. Significantly decreased levels of phosphatidylcholines, plasmanyls, sphingomyelins, lysophosphatidylcholines, phosphatidylethanolamines, phosphatidylinositols, phosphatidylserines, and eicosanoids were observed in patients with fatigue. Network and metabolic pathway analysis indicated a dysregulation of the arachidonic acid and glycerophospholipid metabolisms and the sphingolipid pathway. The protein-metabolite interaction network showed interactions between functionally related metabolites and proteins, displaying 40 disease-associated hidden proteins including ABDH4, GLTP, and LCAT.
Collapse
Affiliation(s)
- Diana Horta
- Digestive Diseases Service, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, 08208 Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, 08193 Spain
| | - Marta Moreno-Torres
- Unidad de Hepatología Experimental, Health Research Institute La Fe, Valencia, 46026 Spain
| | - María José Ramírez-Lázaro
- Digestive Diseases Service, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, 08208 Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas CIBERehd, Instituto de Salud Carlos III, Madrid, 28029 Spain
| | - Sergio Lario
- Digestive Diseases Service, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, 08208 Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas CIBERehd, Instituto de Salud Carlos III, Madrid, 28029 Spain
| | - Julia Kuligowski
- Neonatal Research Group, Health Research Institute La Fe, Valencia, 46026 Spain
| | | | - Guillermo Quintas
- Health and Biomedicine, LEITAT Technological Center, Barcelona, 08028 Spain.,Unidad Analítica, Health Research Institute Hospital La Fe, Valencia, 46026 Spain
| | - Albert Villoria
- Digestive Diseases Service, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, 08208 Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, 08193 Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas CIBERehd, Instituto de Salud Carlos III, Madrid, 28029 Spain
| | - Xavier Calvet
- Digestive Diseases Service, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, 08208 Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, 08193 Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas CIBERehd, Instituto de Salud Carlos III, Madrid, 28029 Spain
| |
Collapse
|
31
|
Scott AJ, Flowers O, Rowse G. Do specific types of sleep disturbances represent risk factors for poorer health-related quality of life in inflammatory bowel disease? A longitudinal cohort study. Br J Health Psychol 2020; 26:90-108. [PMID: 32634291 DOI: 10.1111/bjhp.12457] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 06/12/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Poor global sleep quality is commonly reported in people with inflammatory bowel disease (IBD) and is linked to poorer health-related quality of life (HRQoL). However, understanding is currently limited by a lack of: (1) longitudinal research and (2) research investigating the impact of specific types of problems sleeping on IBD-related outcomes, particularly on HRQoL. DESIGN Observational longitudinal cohort study. METHODS N = 276 participants with IBD completed measures at baseline (T1) and 4 weeks later at T2. Four specific sleep disturbances associated with IBD including sleep apnoea, insomnia, restless legs, and nightmares were measured alongside depression, anxiety and stress, and HRQoL. RESULTS After controlling for participant demographics and clinical characteristics, T1 depression, anxiety, stress, and T1 HRQoL, more severe symptom severity of sleep apnoea (B = -0.30, p < .05) and insomnia symptoms (B = -0.23, p < .05) at T1 significantly predicted poorer HRQoL at T2. However, the experience of restless legs (B = -0.03, p > .87) and nightmares (B = -0.14, p > .11) at T1 did not predict HRQoL. CONCLUSION Symptoms synonymous with sleep apnoea and insomnia might represent modifiable risk factors that provide independent contributions to HRQoL over time in those with IBD. These findings suggest that interventions designed to improve sleep apnoea and insomnia could confer benefits to HRQoL in those with IBD. However, more longitudinal research is needed to understand the contribution of sleep disturbances over the longer term, as well as more randomized controlled trials testing the effect of improving sleep on IBD-related outcomes.
Collapse
Affiliation(s)
- Alexander J Scott
- School of Health & Related Research (ScHARR), University of Sheffield, UK
| | - Olivia Flowers
- School of Health & Related Research (ScHARR), University of Sheffield, UK
| | - Georgina Rowse
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, UK
| |
Collapse
|
32
|
Abstract
PURPOSE OF REVIEW Fatigue, a protean complaint encompassing both physical, mental exhaustion but also demotivation, has shown to effect quality of life in patients with inflammatory bowel disease (IBD). Here we present a review of the literature as it relates to IBD-associated fatigue. Moreover, we present the common causes attributed to fatigue and present an algorithmic approach to the assessment of fatigue. Finally, we report data regarding potential management strategies for IBD-associated fatigue. RECENT FINDINGS Unfortunately, owing to its multidimensional nature and multifactorial causes, patients with IBD may continue to report fatigue despite optimization of disease management, replenishment of nutritional deficiencies, or management of coexistent disorders. Management likely requires a multidisciplinary approach. SUMMARY The majority of patients with IBD report fatigue symptoms both in setting of active disease but also during the course of remission. Fatigue is a multidimensional complaints, and management likely requires a multidisciplinary approach. Herein, we present a framework for the management and assessment of fatigue in IBD.
Collapse
|
33
|
Banovic I, Montreuil L, Derrey-Bunel M, Scrima F, Savoye G, Beaugerie L, Gay MC. Toward Further Understanding of Crohn's Disease-Related Fatigue: The Role of Depression and Emotional Processing. Front Psychol 2020; 11:703. [PMID: 32425848 PMCID: PMC7204397 DOI: 10.3389/fpsyg.2020.00703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 03/23/2020] [Indexed: 01/19/2023] Open
Abstract
Because the relationship between Crohn’s Disease (CD) activity and CD-related fatigue remains poorly understood, this study investigated the role of underlying psychological processes (depression, anxiety, and emotional processing). It was expected that the relationship between CD activity and CD-related fatigue would be mediated by depression and anxiety and also by a deficit in emotional processing. This prediction was tested in 110 CD patients who completed self-reported questionnaires assessing fatigue (FSS), clinical activity of Crohn’s Disease (HBAI), psychological suffering (HADS), and emotional processing (EPS-25). A path analysis showed both direct and indirect effects in the relationship between CD activity and CD-related fatigue, accounting for 33% of the variance. One indirect effect on the experience of fatigue was depression, but there was no effect of anxiety. These preliminary results confirmed that disease activity induces an increase in depressive symptoms, which in turn leads to an increase in the level of fatigue. The most novel result of the present study is that emotional processing had an indirect effect on the relationship between CD and CD-related fatigue: when the disease was more active, patients exhibited greater disruption of emotional processing, which in turn led to greater fatigue. These results did not reveal any association between depression and emotional processing. In conclusion, this work highlights the role of emotional processing in CD-related fatigue and the importance of taking this factor into account in order to manage this condition better.
Collapse
Affiliation(s)
- Ingrid Banovic
- CRFDP (EA7475), Rouen Normandy University, UFR SHS, Mont-Saint-Aignan, France
| | - Louise Montreuil
- CRFDP (EA7475), Rouen Normandy University, UFR SHS, Mont-Saint-Aignan, France
| | - Marie Derrey-Bunel
- CRFDP (EA7475), Rouen Normandy University, Hôpital Jacques Monod, Montivilliers, France
| | - Fabrizio Scrima
- CRFDP (EA7475), Rouen Normandy University, UFR SHS, Mont-Saint-Aignan, France
| | | | | | | |
Collapse
|
34
|
Fatigue, Physical Activity, and Mental Health in People Living With Inflammatory Bowel Disease, Fibromyalgia, and in Healthy Controls: A Comparative Cross-Sectional Survey. Gastroenterol Nurs 2020; 43:172-185. [PMID: 32251219 DOI: 10.1097/sga.0000000000000415] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
This study aimed to identify biopsychosocial factors associated with fatigue, physical activity, and perceived benefits of and barriers to exercise in adults with inflammatory bowel disease and to compare them with those with fibromyalgia and healthy controls. A cross-sectional online survey was conducted. Hierarchical linear regressions were used to examine correlates of fatigue and physical activity. Analysis of variance and Kruskal-Wallis tests were used to compare levels of fatigue and physical activity between the groups. Overall, 387 participants completed the study (inflammatory bowel disease: n = 232; fibromyalgia: n = 102; healthy controls: n = 53). Significant correlates of fatigue included pain catastrophizing (p = .006), sleep quality (p = .003), and depressive symptoms (p < .001). Perceived barriers to exercise were associated with depressive symptoms (p = .003). Correlates of perceived benefits of exercise included anxiety (p = .036), depressive symptoms (p = .014), coping (positive reframing) (p = .018), and social support (from family) (p = .033). The fibromyalgia group had the greatest fatigue interference and the lowest score for physical activity, followed by the inflammatory bowel disease group and healthy controls (p < .05). Given the interplay between depressive symptoms, fatigue, and benefits/barriers to exercise, there is a need for more psychological interventions to be developed and tested in order to reduce fatigue and increase physical activity to better manage disease-related outcomes.
Collapse
|
35
|
Mikocka-Walus A, Hanlon I, Dober M, Emerson C, Beswick L, Selinger C, Taylor J, Olive L, Evans S, Hewitt C. Lived experience in people with inflammatory bowel disease and comorbid anxiety and depression in the United Kingdom and Australia. J Health Psychol 2020; 26:2290-2303. [PMID: 32175775 DOI: 10.1177/1359105320911427] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
This study explored the lived experience of people with inflammatory bowel disease and anxiety/depression. It utilised a deductive biopsychosocial framework. Overall, 24 patients and 20 healthcare professionals from two countries participated. In the United Kingdom, the main themes included (1) bidirectional relationship between inflammatory bowel disease and mental health, (2) the need for healthcare integration and (3) lack of awareness about the disease. In Australia, (1) the 'vicious cycle' of inflammatory bowel disease and psychosocial health, (2) the need for biopsychosocial healthcare integration and (3) the stigma of a hidden disease. Better communication around mental illness is essential in improving inflammatory bowel disease healthcare.
Collapse
|
36
|
Canakis A, Qazi T. Sleep and Fatigue in IBD: an Unrecognized but Important Extra-intestinal Manifestation. Curr Gastroenterol Rep 2020; 22:8. [PMID: 32002666 DOI: 10.1007/s11894-020-0746-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE OF REVIEW The bidirectional relationship between sleep disorders and inflammatory bowel disease (IBD) has gained considerable attention in recent years. It has been suggested that poor sleep and fatigue are extra-intestinal manifestations of IBD. This review reports recent studies exploring subjective and objective assessments of sleep in the adult IBD population. RECENT FINDINGS In ulcerative colitis patients, poor sleep has been independently linked to depression and poorer IBD-related quality of life. Using home polysomnography, IBD patients were shown to have less rapid eye movement sleep and Crohn's patient had increased lighter sleep. A study utilizing surveys assessing circadian rhythms described circadian misalignment in IBD patients and reported that circadian misalignment in Crohn's disease was associated with a more aggressive disease phenotype. The use of biologics may improve sleep disturbances in patients with IBD. Translational and clinical studies have reported that disturbances in sleep quality are linked to intestinal inflammation and a heighted systemic immune response. IBD patients appear to have disturbed sleep. Poor sleep is also suggested as a marker for subclinical disease activity. Recent studies have suggested circadian misalignment in IBD patients, and future studies are needed to assess these clinical implications.
Collapse
Affiliation(s)
- Andrew Canakis
- Department of Internal Medicine, Boston University School of Medicine, 72 East Concord St, Evans 124, Boston, MA, 02118, USA.
| | - Taha Qazi
- Department of Gastroenterology, Hepatology & Nutrition, Digestive Diseases Institute, Cleveland Clinic, A30, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| |
Collapse
|
37
|
Scott AJ, Flowers O, Rowse G. A comparative study of the nature and magnitude of problems sleeping in inflammatory bowel disease (IBD) compared to healthy controls. PSYCHOL HEALTH MED 2020; 25:958-968. [DOI: 10.1080/13548506.2019.1707240] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Alexander J. Scott
- The School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Olivia Flowers
- The School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Georgina Rowse
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| |
Collapse
|
38
|
Nocerino A, Nguyen A, Agrawal M, Mone A, Lakhani K, Swaminath A. Fatigue in Inflammatory Bowel Diseases: Etiologies and Management. Adv Ther 2020; 37:97-112. [PMID: 31760611 PMCID: PMC6979464 DOI: 10.1007/s12325-019-01151-w] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Indexed: 12/11/2022]
Abstract
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.
Collapse
Affiliation(s)
| | - Andrew Nguyen
- Lenox Hill Hospital, Northwell Health System, New York, NY, USA
| | - Manasi Agrawal
- Department of Gastroenterology, Mount Sinai Hospital, New York, NY, USA
| | - Anjali Mone
- Lenox Hill Hospital, Northwell Health System, New York, NY, USA
| | - Komal Lakhani
- Lenox Hill Hospital, Northwell Health System, New York, NY, USA
| | - Arun Swaminath
- Lenox Hill Hospital, Northwell Health System, New York, NY, USA.
| |
Collapse
|
39
|
Frigstad SO, Høivik ML, Jahnsen J, Cvancarova M, Grimstad T, Berset IP, Huppertz-Hauss G, Hovde Ø, Bernklev T, Moum B, Jelsness-Jørgensen LP. Pain Severity and Vitamin D Deficiency in IBD Patients. Nutrients 2019; 12:nu12010026. [PMID: 31877637 PMCID: PMC7019855 DOI: 10.3390/nu12010026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 12/10/2019] [Accepted: 12/18/2019] [Indexed: 12/22/2022] Open
Abstract
Background: Pain and vitamin D deficiency are common in inflammatory bowel disease (IBD). Disease activity, fatigue, frequent relapses, prior surgery and psychological factors all seem to influence the experience of pain in IBD. Vitamin D deficiency has been associated with muscle and skeletal pain. This study aimed to determine whether there is an association between vitamin D deficiency and severity of pain in patients with IBD, and to investigate the influence of other socio-demographic and psychological variables on the experience of pain. Methods: Patients with IBD were recruited from nine hospitals in Norway in a multicenter cross-sectional study. The Brief Pain Inventory (BPI) questionnaire was used to measure pain. Disease activity was assessed using clinical disease activity indices, C-reactive protein (CRP) and fecal calprotectin. Regression models were fitted to explore a possible association between 25-hydroxyvitamin D and pain severity. Results: Of 407 patients included in the analyses, 229 (56%) had Crohn’s disease (CD) and 178 (44%) had ulcerative colitis (UC). Vitamin D deficiency was present in half (203/407) of patients. Presence of pain was reported by 76% (309/407). More severe pain was associated with female gender and increased disease activity scores, but not with increased CRP or fecal calprotectin. In CD, patients without prior intra-abdominal surgery reported more severe pain. In multivariate analyses, there was no association between 25-hydroxyvitamin D and pain severity. Conclusions: In this study, no significant association between pain severity and vitamin D deficiency was revealed in patients with IBD.
Collapse
Affiliation(s)
- Svein Oskar Frigstad
- Department of Research, Østfold Hospital, 1714 Grålum, Norway
- Department of Medicine, Vestre Viken Bærum Hospital, 1346 Gjettum, Norway
- Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway; (M.L.H.); (J.J.); (I.P.B.); (Ø.H.); (T.B.); (B.M.)
- Correspondence: ; Tel.: +47-6780-9587
| | - Marte Lie Høivik
- Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway; (M.L.H.); (J.J.); (I.P.B.); (Ø.H.); (T.B.); (B.M.)
- Department of Gastroenterology, Oslo University Hospital, 0424 Oslo, Norway;
| | - Jørgen Jahnsen
- Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway; (M.L.H.); (J.J.); (I.P.B.); (Ø.H.); (T.B.); (B.M.)
- Department of Gastroenterology, Akershus University Hospital, 1478 Nordbyhagen, Norway
| | - Milada Cvancarova
- Department of Gastroenterology, Oslo University Hospital, 0424 Oslo, Norway;
- Department of Biostatistics, Oslo Metropolitan University, 0130 Oslo, Norway
| | - Tore Grimstad
- Department of Gastroenterology, Stavanger University Hospital, 4068 Stavanger, Norway;
| | - Ingrid Prytz Berset
- Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway; (M.L.H.); (J.J.); (I.P.B.); (Ø.H.); (T.B.); (B.M.)
| | | | - Øistein Hovde
- Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway; (M.L.H.); (J.J.); (I.P.B.); (Ø.H.); (T.B.); (B.M.)
- Department of Medicine, Innlandet Hospital, 2819 Gjøvik, Norway
| | - Tomm Bernklev
- Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway; (M.L.H.); (J.J.); (I.P.B.); (Ø.H.); (T.B.); (B.M.)
- Department of Research and Development, Vestfold Hospital, 3103 Tønsberg, Norway
| | - Bjørn Moum
- Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway; (M.L.H.); (J.J.); (I.P.B.); (Ø.H.); (T.B.); (B.M.)
- Department of Gastroenterology, Oslo University Hospital, 0424 Oslo, Norway;
| | - Lars-Petter Jelsness-Jørgensen
- Department of Gastroenterology, Østfold Hospital, 1714 Grålum, Norway;
- Department of Health Sciences, Østfold University College, 1757 Halden, Norway
| |
Collapse
|
40
|
Artom M, Czuber-Dochan W, Sturt J, Proudfoot H, Roberts D, Norton C. Cognitive-behavioural therapy for the management of inflammatory bowel disease-fatigue: a feasibility randomised controlled trial. Pilot Feasibility Stud 2019; 5:145. [PMID: 31890258 PMCID: PMC6905023 DOI: 10.1186/s40814-019-0538-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 11/28/2019] [Indexed: 02/08/2023] Open
Abstract
Background Fatigue is the third most prevalent symptom for patients with inflammatory bowel disease (IBD), yet optimal strategies for its management are unclear. Treatment protocols for fatigue in other conditions have been based on cognitive-behavioural models. Targeting cognitions, emotions and behaviour related to fatigue through cognitive-behavioural therapy (CBT) may be a viable option to improve fatigue and quality of life (QoL) in IBD. Methods This single centre, two-arm, feasibility randomised controlled trial (RCT) aimed to assess the feasibility and initial estimates of potential efficacy of a CBT intervention for the management of IBD-fatigue. Feasibility, acceptability and initial estimates of potential efficacy outcomes were collected through self-report measures and semi-structured interviews. Participants were recruited from one tertiary referral centre. Intervention Group 1 received a CBT manual for fatigue, one 60-min and seven 30-min telephone sessions with a therapist over 8-weeks. Control Group 2 received a fatigue information sheet without therapist support. A nested qualitative study evaluated patients’ and therapists’ experiences, and IBD-healthcare professionals’ (HCPs) perceptions of the intervention. Results Eighty-nine participants were assessed for eligibility. Of these, 31 of the 70 eligible participants consented to participate (recruitment rate of 44%). Of the 15 participants randomised to the intervention group, 13 (87%) started it and 10 (77% of those who started) completed all 8 sessions. Follow-up questionnaires were completed by 22 (71%) participants at 3 months, 14 (45%) at 6 months and 12 (39%) at 12 months’ follow-up. The intervention was acceptable to participants and feasible for therapists to deliver. HCPs reported that the intervention would be applicable, but time, finance and training constraints limit its implementation. Initial estimates of potential efficacy with complete case analysis showed a reduction in fatigue and an increase in QoL at 3, 6 and 12 months post-randomisation. Conclusions A full-scale effectiveness RCT testing CBT for IBD-fatigue is feasible and is potentially worthwhile with some changes to the protocol. However, given the small numbers, further pilot work is warranted before a full-scale RCT. Trial registration Registration Trial ISRCTN 17917944, Registered 2 September 2016
Collapse
Affiliation(s)
- Micol Artom
- 1Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA UK
| | - Wladyslawa Czuber-Dochan
- 1Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA UK
| | - Jackie Sturt
- 1Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA UK
| | - Hannah Proudfoot
- 2Tobacco & Alcohol Research Group, University College London, London, UK
| | - Danniella Roberts
- 1Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA UK
| | - Christine Norton
- 1Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA UK
| |
Collapse
|
41
|
Chavarría C, Casanova MJ, Chaparro M, Barreiro-de Acosta M, Ezquiaga E, Bujanda L, Rivero M, Argüelles-Arias F, Martín-Arranz MD, Martínez-Montiel MP, Valls M, Ferreiro-Iglesias R, Llaó J, Moraleja-Yudego I, Casellas F, Antolín-Melero B, Cortés X, Plaza R, Pineda JR, Navarro-Llavat M, García-López S, Robledo-Andrés P, Marín-Jiménez I, García-Sánchez V, Merino O, Algaba A, Arribas-López MR, Banales JM, Castro B, Castro-Laria L, Honrubia R, Almela P, Gisbert JP. Prevalence and Factors Associated With Fatigue in Patients With Inflammatory Bowel Disease: A Multicentre Study. J Crohns Colitis 2019; 13:996-1002. [PMID: 30721954 DOI: 10.1093/ecco-jcc/jjz024] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 12/19/2018] [Accepted: 01/27/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS The aims of this study were to determine the prevalence of fatigue in patients with inflammatory bowel disease [IBD], to identify the factors associated with fatigue and its severity, to assess the impact of fatigue on quality of life [QoL], and to evaluate the relationship between fatigue and sleep disorders. METHODS This was a prospective multicentre study conducted at 22 Spanish centres. Consecutive patients followed at IBD Units were included. Fatigue was evaluated with the Fatigue Severity Scale [FSS] and the Fatigue Impact Scale [FIS]. Quality of life and sleep quality were assessed using the IBD Questionnaire-Short Form [IBDQ-9] and the Pittsburgh Sleep Quality Index [PSQI], respectively. RESULTS A total of 544 consecutive adult IBD patients were included [50% women, mean age 44 years, 61% Crohn's disease]. The prevalence of fatigue was 41% (95% confidence interval [CI] = 37-45%). The variables associated with an increased risk of fatigue were: anxiety [OR = 2.5, 95% CI = 1.6-3.7], depression [OR = 2.4, 95% CI = 1.4-3.8], presence of extraintestinal manifestations [EIMs] [OR = 1.7, 95% CI = 1.1-2.6], and treatment with systemic steroids [OR = 2.8, 95% CI = 1.4-5.7]. The presence of EIMs [regression coefficient, RC = 8.2, 95% CI = 2.3-14.2], anxiety [RC = 25.8, 95% CI = 20.0-31.5], depression [RC = 30.6, 95% CI = 24.3-37.0], and sleep disturbances [RC = 15.0, 95% CI = 9.3-20.8] were associated with severity of fatigue. Patients with fatigue had a significantly decreased IBDQ-9 score [p < 0.001]. CONCLUSIONS The prevalence of fatigue in IBD patients is remarkably high and has a negative impact on QoL. Therapy with systemic steroids is associated with an increased risk of fatigue. The severity of fatigue is associated with anxiety, depression, sleep disorders, and the presence of EIMs. Fatigue was not associated with anaemia, disease activity or anti-TNF therapy.
Collapse
Affiliation(s)
- C Chavarría
- Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa [IIS-IP] and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas [CIBEREHD], Madrid, Spain
| | - M J Casanova
- Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa [IIS-IP] and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas [CIBEREHD], Madrid, Spain
| | - M Chaparro
- Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa [IIS-IP] and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas [CIBEREHD], Madrid, Spain
| | - M Barreiro-de Acosta
- Department of Gastroenterology, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - E Ezquiaga
- Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa [IIS-IP] and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas [CIBEREHD], Madrid, Spain.,Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa [IIS-IP] and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas [CIBEREHD], Madrid, Spain
| | - L Bujanda
- Department of Gastroenterology, Instituto Biodonostia, Universidad del País Vasco [UPV/EHU] and CIBEREHD, San Sebastián, Spain
| | - M Rivero
- Hospital Universitario Marqués de Valdecilla and Instituto de Investigación Marqués de Valdecilla [IDIVAL], Santander, Spain
| | - F Argüelles-Arias
- Department of Gastroenterology, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - M D Martín-Arranz
- Department of Gastroenterology, Hospital Universitario La Paz, Madrid, Spain
| | - M P Martínez-Montiel
- Department of Gastroenterology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - M Valls
- Hospital General Universitario de Castellón, Castellón, Spain
| | - R Ferreiro-Iglesias
- Department of Gastroenterology, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - J Llaó
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - I Moraleja-Yudego
- Department of Gastroenterology, Hospital Galdakao-Usansolo, Galdakao, Spain
| | - F Casellas
- Department of Gastroenterology, Hospital Universitari Vall d'Hebron and CIBEREHD, Barcelona, Spain
| | - B Antolín-Melero
- Department of Gastroenterology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - X Cortés
- Department of Gastroenterology, Hospital de Sagunto, Valencia, Spain
| | - R Plaza
- Department of Gastroenterology, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - J R Pineda
- Department of Gastroenterology, Complejo Hospitalario Universitario de Vigo, Vigo, Spain
| | - M Navarro-Llavat
- Department of Gastroenterology, Hospital de Sant Joan Despí Moisès Broggi, Barcelona, Spain
| | - S García-López
- Department of Gastroenterology, Hospital Universitario Miguel Servet and CIBEREHD, Zaragoza, Spain
| | - P Robledo-Andrés
- Department of Gastroenterology, Hospital San Pedro de Alcántara, Cáceres, Spain
| | - I Marín-Jiménez
- Department of Gastroenterology, Hospital General Universitario Gregorio Marañón and CIBEREHD, Madrid, Spain
| | - V García-Sánchez
- Department of Gastroenterology, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - O Merino
- Department of Gastroenterology, Hospital Universitario de Cruces, Bilbao, Spain
| | - A Algaba
- Department of Gastroenterology, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | - M R Arribas-López
- Department of Gastroenterology, Hospital Universitario Infanta Sofía, Madrid, Spain
| | - J M Banales
- Department of Gastroenterology, Instituto Biodonostia, Universidad del País Vasco [UPV/EHU] and CIBEREHD, San Sebastián, Spain
| | - B Castro
- Hospital Universitario Marqués de Valdecilla and Instituto de Investigación Marqués de Valdecilla [IDIVAL], Santander, Spain
| | - L Castro-Laria
- Department of Gastroenterology, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - R Honrubia
- Department of Gastroenterology, Hospital Universitario La Paz, Madrid, Spain
| | - P Almela
- Hospital General Universitario de Castellón, Castellón, Spain
| | - J P Gisbert
- Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa [IIS-IP] and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas [CIBEREHD], Madrid, Spain
| |
Collapse
|
42
|
Sexton KA, Walker JR, Targownik LE, Graff LA, Haviva C, Beatie BE, Petty SK, Bernstein MT, Singh H, Miller N, Bernstein CN. The Inflammatory Bowel Disease Symptom Inventory: A Patient-report Scale for Research and Clinical Application. Inflamm Bowel Dis 2019; 25:1277-1290. [PMID: 30918969 PMCID: PMC6635838 DOI: 10.1093/ibd/izz038] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Existing measures of inflammatory bowel disease (IBD) symptoms are not well suited to self-report, inadequate in measurement properties, insufficiently specific, or burdensome for brief or repeated administration. We aimed to develop a patient-reported outcome measure to assess a broader range of IBD symptoms. METHODS The IBD Symptoms Inventory (IBDSI) was developed by adapting symptom items from existing clinician-rated or diary-format inventories; after factor analysis, 38 items were retained on 5 subscales: bowel symptoms, abdominal discomfort, fatigue, bowel complications, and systemic complications. Participants completed the IBDSI and other self-report measures during a clinic visit. A nurse administered the Harvey Bradshaw Index (HBI) for Crohn's disease (CD) or the Powell-Tuck Index (PTI) for ulcerative colitis (UC), and a gastroenterologist completed a global assessment of disease severity (PGA). RESULTS The 267 participants with CD (n = 142) or UC (n = 125), ages 18 to 81 (M = 43.4, SD = 14.6) were 58.1% female, with a mean disease duration of 13.9 (SD = 10.5) years. Confirmatory factor analysis supported the 5 subscales. The total scale and subscales showed good reliability and significant correlations with self-report symptom and IBD quality of life measures, the HBI, PTI, and PGA. CONCLUSIONS The IBDSI showed strong measurement properties: a supported factor structure, very good internal consistency, convergent validity, and excellent sensitivity and specificity to clinician-rated active disease. Self-report HBI and PTI items, when extracted from this measure, produced scores comparable to clinician-administered versions. The 38-item IBDSI, or 26-item short form, can be used as a brief survey of common IBD symptoms in clinic or research settings.
Collapse
Affiliation(s)
- Kathryn A Sexton
- Department of Inflammatory Bowel Disease Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada,Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - John R Walker
- Department of Inflammatory Bowel Disease Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada,Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Laura E Targownik
- Department of Inflammatory Bowel Disease Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada,Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lesley A Graff
- Department of Inflammatory Bowel Disease Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada,Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Clove Haviva
- Department of Inflammatory Bowel Disease Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada,Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Brooke E Beatie
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sarah K Petty
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Matthew T Bernstein
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada,Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Harminder Singh
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Norine Miller
- Department of Inflammatory Bowel Disease Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Charles N Bernstein
- Department of Inflammatory Bowel Disease Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada,Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada,Address correspondence to: Charles N. Bernstein, Department of Internal Medicine (Gastroenterology), University of Manitoba, 804F-715 McDermot Avenue, University of Manitoba, Winnipeg, MB R3E3P4, Canada. E-mail:
| |
Collapse
|
43
|
Qazi T, Verma R, Hamilton MJ, Kaplan ER, Redline S, Burakoff R. The Use of Actigraphy Differentiates Sleep Disturbances in Active and Inactive Crohn's Disease. Inflamm Bowel Dis 2019; 25:1044-1053. [PMID: 30395256 DOI: 10.1093/ibd/izy324] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Sleep disturbances (SDs) are commonly reported in patients with Crohn's disease (CD). Several survey instruments assessing subjective measures of insufficient sleep have identified SDs in subjects with CD. However, there are limited data on objective measures of SDs in these patients as they relate to disease activity. In this prospective cross-sectional study, we compared objective estimates of sleep obtained using multiday wrist actigraphy in individuals with CD with varying disease activity. METHODS Eighty patients with a diagnosis of CD were recruited to take part in the study. Participants were stratified by disease activity into remission, mild disease, and moderate to severe disease groups using the Harvey-Bradshaw Index and C-reactive protein levels. Participants were excluded on the basis of significant comorbidity (Charlson Comorbidity Index ≥3), a known history of a sleep disorder, or the concomitant use of systemic corticosteroids. Participants completed surveys, including the PROMIS-SD Short Form 8a, the Epworth Sleepiness Scale, and the Women's Health Initiative Insomnia Rating scale, and were provided with an accelerometer that estimated sleep-wake patterns over 7 days. Comparisons of actigraphic sleep parameters were performed between disease activity groups. Multivariate logistic regression analyses were performed using covariates determined a priori to have an association with sleep disturbance in CD through a review of the literature. RESULTS Of the 80 participants enrolled in the study, 72 completed 5 days of actigraphy data: 28 subjects in remission, 22 subjects with mild disease activity, and 22 subjects with moderate to severe disease activity. Self-reported sleep characteristics assessed by questionnaires were similar between groups. By actigraphy, individuals with moderate to severe CD spent a significantly longer time awake after falling asleep compared with subjects with remissive disease or compared with subjects with mild disease (65.8 minutes vs 44.3 minutes and 49.1 minutes, respectively; each P < 0.05). Individuals with moderate to severe CD had significantly lower sleep efficiency compared with those with remissive CD (86.6% vs 89.9%; P = 0.03). In the multivariate analyses, moderate to severe CD disease activity was significantly associated with an increased amount of fragmented sleep (odds ratio [OR], 3.70; 95% confidence interval [CI], 1.23-11.32; P = 0.02; WASO ≥ 60 minutes). Moreover, the use of controlled substances was associated with poor sleep efficiency (OR, 3.86; 95% CI, 1.01-14.7; P = 0.04; SE ≤ 85.5%). CONCLUSIONS This is the first study to objectively quantify disturbed sleep using wrist actigraphy in adults with CD with varying disease activity. Wrist actigraphy may serve as a useful modality for discerning SD in subjects with active vs remissive disease that is not evident with questionnaires alone. Although we determined that disease severity is a significant factor that leads to SDs in CD, larger studies using these objective measures may help determine the contribution of other factors.
Collapse
Affiliation(s)
- Taha Qazi
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts
| | - Rashmi Verma
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts
| | - Matthew J Hamilton
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts
| | - Emily R Kaplan
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Massachusetts
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Massachusetts
| | - Robert Burakoff
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York City, New York
| |
Collapse
|
44
|
Bager P, Vestergaard C, Juul T, Dahlerup JF. Population-based normative data for the inflammatory bowel disease fatigue scale - IBD-F. Scand J Gastroenterol 2019; 53:1274-1279. [PMID: 30351212 DOI: 10.1080/00365521.2018.1521868] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Fatigue is a common concern among patients with inflammatory bowel disease (IBD). The Inflammatory Bowel Disease Fatigue (IBD-F) scale was developed in 2014 together with patients with IBD. The IBD-F comprises five questions about the frequency and severity of fatigue followed by 30 questions about the experience and impact of fatigue. All questions have generic character. Normative values are needed if the IBD-F scale is to be used extensively. This study aims to generate normative values for the IBD-F scale in a Danish background population. MATERIALS AND METHODS An age- and gender-stratified random sample of 3460 Danes was drawn from the total population. The IBD-F and a few socio-demographic questions were administered electronically. RESULTS Of the 3460 drawn individuals, 2952 citizens with electronic access were invited to participate, 1925 (65.2%) citizens accepted the invitation, and 1761 (59.7%) completed the IBD-F questionnaire. Overall, women had more fatigue than men (the frequency and severity, 7.2 vs. 6.6; p < .001) (the experience and impact, 17.0 vs. 13.5; p < .001). Fatigue was most marked for citizens <50 and ≥80 years old. Having no education, working part time, and morbidity were factors associated with more fatigue. Co-habitation was associated with less fatigue. The internal consistency in this population revealed Cronbach's alpha values >0.85. CONCLUSIONS The IBD-F scale can be used in the background population and this study provides normative data for fatigue. Fatigue was higher for women and specific age groups. Several socio-demographic and morbidity variables were associated with fatigue.
Collapse
Affiliation(s)
- Palle Bager
- a Department of Hepatology and Gastroenterology , Aarhus University Hospital , Aarhus , Denmark
| | - Charlotte Vestergaard
- a Department of Hepatology and Gastroenterology , Aarhus University Hospital , Aarhus , Denmark
| | - Therese Juul
- b Department of Surgery , Aarhus University Hospital , Aarhus , Denmark
| | - Jens F Dahlerup
- a Department of Hepatology and Gastroenterology , Aarhus University Hospital , Aarhus , Denmark
| |
Collapse
|
45
|
Qazi T, Farraye FA. Sleep and Inflammatory Bowel Disease: An Important Bi-Directional Relationship. Inflamm Bowel Dis 2019; 25:843-852. [PMID: 30388243 DOI: 10.1093/ibd/izy334] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Indexed: 12/12/2022]
Abstract
Sleep deprivation and lack of sleep are a significant public health concern. Several studies have suggested an intricate relationship between sleep, inflammation, and the immune system. Poor sleep has been described well in subjects with inflammatory bowel disease (IBD) and has been linked to disease activity and shown as a predictor for subclinical inflammation and a risk factor for relapse and poorer outcomes. This review describes the relationship between poor sleep, inflammation, and the immune system. Furthermore, the relationship between sleep and IBD are reviewed. The causes of poor sleep in inflammatory bowel disease patient is discussed. Potential therapeutic interventions for the management of common sleep disturbances are provided.
Collapse
Affiliation(s)
- Taha Qazi
- Section of Gastroenterology, Boston University Medical Center, Boston, Massachusetts, USA
| | - Francis A Farraye
- Section of Gastroenterology, Boston University Medical Center, Boston, Massachusetts, USA
| |
Collapse
|
46
|
Borren NZ, van der Woude CJ, Ananthakrishnan AN. Fatigue in IBD: epidemiology, pathophysiology and management. Nat Rev Gastroenterol Hepatol 2019; 16:247-259. [PMID: 30531816 DOI: 10.1038/s41575-018-0091-9] [Citation(s) in RCA: 122] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Fatigue is an important clinical problem in patients with IBD, affecting nearly 50% of patients in clinical remission and > 80% of those with active disease. The resulting decrease in quality of life and impaired work productivity and functioning contribute markedly to the societal costs of fatigue. However, despite the burden and effects of fatigue, little is known about its aetiology and pathophysiology, which impairs our ability to effectively treat this symptom. Here, we review the theories behind the development of fatigue in IBD and the role of contributing factors, including nutritional deficiency, inflammation and altered metabolism. We also explore the potential role of the gut microbiome in mediating fatigue and other psychological symptoms through the gut-brain axis. We discuss the efficacy of nutrient repletion and various psychological and pharmacological interventions on relieving fatigue in patients with IBD and expand the discussion to non-IBD-related fatigue when evidence exists. Finally, we present a therapeutic strategy for the management of fatigue in IBD and call for further mechanistic and clinical research into this poorly studied symptom.
Collapse
Affiliation(s)
- Nienke Z Borren
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA.,Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, Netherlands
| | - C Janneke van der Woude
- Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, Netherlands
| | | |
Collapse
|
47
|
Gombert M, Carrasco-Luna J, Pin-Arboledas G, Codoñer-Franch P. The connection of circadian rhythm to inflammatory bowel disease. Transl Res 2019; 206:107-118. [PMID: 30615844 DOI: 10.1016/j.trsl.2018.12.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 11/25/2018] [Accepted: 12/16/2018] [Indexed: 02/07/2023]
Abstract
Inflammatory bowel disease (IBD) comprises a group of chronic, immune system-mediated inflammatory diseases that primarily affect the gastrointestinal tract. The pathogenesis of the intestinal lesions in IBD remains elusive, but the inflammation process could be the result of dysfunction of the innate and adaptive immune systems induced by genetic and environmental factors. In recent years, research has demonstrated a connection between environmental stressors that can influence day-night variations, also called circadian rhythms, and digestive health. In this review, we focus on alterations in the complex interactions between intestinal mucosa, microbial factors, and the immune response in the intestinal milieu. We introduce the mechanisms that establish circadian rhythms and their regulation by the circadian rhythm genes. Evidence of circadian variation in the defense mechanisms of the intestine and its implication in the maintenance of a healthy microbiota are presented. Disruption of the circadian system can increase the activity of the gut immune system and the release of inflammatory factors. The link between chronodisruption or circadian rhythm impairment and IBD demonstrated by experimental and clinical studies illustrates the potential impact of circadian rhythms on treatment of these diseases. Future studies that investigate aspects of this subject are warranted.
Collapse
Affiliation(s)
- Marie Gombert
- Department of Pediatrics, Obstetrics and Gynecology, University of Valencia, Valencia, Spain; Department of Biotechnology, University of La Rochelle, La Rochelle, France
| | - Joaquín Carrasco-Luna
- Department of Pediatrics, Obstetrics and Gynecology, University of Valencia, Valencia, Spain; Department Experimental Sciences, Catholic University of Valencia, Valencia, Spain
| | - Gonzalo Pin-Arboledas
- Department of Pediatrics, Pediatric Sleep Unit, Hospital Quironsalud, Valencia, Spain
| | - Pilar Codoñer-Franch
- Department of Pediatrics, Obstetrics and Gynecology, University of Valencia, Valencia, Spain; Department of Pediatrics, Dr. Peset University Hospital, Valencia, Spain.
| |
Collapse
|
48
|
Moulton CD, Pavlidis P, Norton C, Norton S, Pariante C, Hayee B, Powell N. Depressive symptoms in inflammatory bowel disease: an extraintestinal manifestation of inflammation? Clin Exp Immunol 2019; 197:308-318. [PMID: 30762873 DOI: 10.1111/cei.13276] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2019] [Indexed: 12/17/2022] Open
Abstract
Depressive symptoms are reported by more than 20% of people with inflammatory bowel disease (IBD), while sleep difficulties and fatigue are even more common. Co-morbid depressive symptoms predict a poor IBD course, including increased risk of relapse and surgery, which is inconsistently improved by psychological treatments. Rather than being distinct systems, there is compelling evidence for bidirectional communication between gut and brain, driven by neural, metabolic, endocrine and inflammatory mediators. An emerging concept is that depressive symptoms may be mechanistically linked to excess inflammation and dysregulation of the gut-brain axis. Given the close link between the intestinal microbiota and host immune responses, patients prone to shifts in their intestinal microbiome, including smokers, those with poor diet and early life stress, may be exposed to exaggerated immune responses. Excess inflammation is associated with brain changes (depressive symptoms, fatigue, sleep difficulties) and worsening gastrointestinal symptoms, which are exacerbated by psychological distress. Equally, treatments both for depressive symptoms and IBD provide opportunities to break this cycle by reducing the causes and effects of inflammation. As well as addressing potential risk factors such as smoking and diet, treatments to alter the microbiome may reduce depressive symptoms. Observational evidence suggests that anti-inflammatory treatments for IBD may improve co-morbid depressive symptoms correlating with reduction in inflammation. With a growing range of treatments targeting inflammation centrally, peripherally and in the gut, IBD provides a unique model to understand the interplay between brain and gut in the pathogenesis of depressive symptoms, both in IBD and in the whole population.
Collapse
Affiliation(s)
- C D Moulton
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - P Pavlidis
- Centre for Inflammation Biology and Cancer Immunology, King's College London, London, UK
| | - C Norton
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - S Norton
- Health Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - C Pariante
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - B Hayee
- Department of Gastroenterology, King's College Hospital NHS Foundation Trust, London, UK
| | - N Powell
- Centre for Inflammation Biology and Cancer Immunology, King's College London, London, UK
| |
Collapse
|
49
|
Tsai SY, Chen HJ, Lio CF, Kuo CF, Kao AC, Wang WS, Yao WC, Chen C, Yang TY. Increased risk of chronic fatigue syndrome in patients with inflammatory bowel disease: a population-based retrospective cohort study. J Transl Med 2019; 17:55. [PMID: 30795765 PMCID: PMC6387539 DOI: 10.1186/s12967-019-1797-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 02/14/2019] [Indexed: 12/13/2022] Open
Abstract
Background Similarities in the symptoms of chronic fatigue syndrome (CFS) and inflammatory bowel disease (IBD) have been observed as follows: severe disease activity in IBD correlates with severe fatigue, major psychiatric signs, the common use of medication, and bacterial translocation. One of several hypotheses for explaining the mechanisms underlying CFS suggests a similarity to the impaired intestinal mucosa of IBD. “This study investigated the risk of incident CFS among patients with IBD”. Methods We conducted a population-based retrospective cohort study by using Taiwan’s National Health Insurance Research Database to evaluate the subsequent risk of CFS in patients with IBD, according to demographic characteristics and comorbidities. The exposure cohort comprised 2163 patients with new diagnoses of IBD. Each patient was randomly selected and frequency matching according to gender and age with four participants from the general population who had no history of CFS at the index date (control cohort). Cox proportional hazards regression analysis was conducted to estimate the relationship between IBD and the subsequent risk of CFS. Results The exposure cohort had a significantly higher overall risk of subsequent CFS than that of the control group [adjusted hazard ratio (Christophi in Inflamm Bowel Dis 18(12):2342–2356, 2012) = 2.25, 95%, confidence interval (Aaron and Buchwald in Ann Intern Med 134(9 Pt 2):868–881, 2001; Farraye et al. in Am J Gastroenterol 112:241, 2017) 1.70–2.99]. Further analysis indicated a significantly higher risk of CFS in patients who were male (HR = 3.23, 95% CI 2.12–4.91), were older than 35 years, and had IBD but without comorbidity status, e.g. Cancers, diabetes, obesity, depression, anxiety, sleep disorder, renal disease (HR = 2.50, 95% CI 1.63–3.84) after adjustment. Conclusion The findings from this population-based retrospective cohort study suggest that IBD, especially Crohn’s disease, is associated with an increased risk of subsequent CFS. Electronic supplementary material The online version of this article (10.1186/s12967-019-1797-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Shin-Yi Tsai
- Department of Laboratory Medicine, MacKay Memorial Hospital, Taipei, Taiwan. .,Department of Medicine, Mackay Medical College, New Taipei City, Taiwan. .,Graduate Institute of Long-Term Care, Mackay Medical College, New Taipei City, Taiwan. .,Graduate Institute of Biomedical Sciences, Mackay Medical College, New Taipei City, Taiwan. .,Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Hsuan-Ju Chen
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - Chon-Fu Lio
- Department of Laboratory Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chien-Feng Kuo
- Institute of Infectious Disease, MacKay Memorial Hospital, Taipei, Taiwan
| | - An-Chun Kao
- Department of Laboratory Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Wei-Shieng Wang
- Institute of Infectious Disease, MacKay Memorial Hospital, Taipei, Taiwan
| | - Wei-Cheng Yao
- Department of Anesthesiology and Pain Medicine, Min-Sheng General Hospital, Tao-Yuan, 330, Taiwan
| | - Chi Chen
- Department of Laboratory Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Tse-Yen Yang
- College of Medicine, China Medical University, Taichung, Taiwan. .,Molecular and Genomic Epidemiology Center, China Medical University Hospital, Taichung, Taiwan. .,Division of Nephrology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan.
| |
Collapse
|
50
|
Abstract
Fatigue is a highly prevalent but relatively ignored problem in IBD patients. It is one of the most burdensome symptoms to the patient with an important impact on the quality of life. Therefore, fatigue is a highly relevant patient-reported outcome that should be included not only in disease activity measurement but also in the endpoints of clinical trials in IBD. However, most of the currently available scoring systems to quantify fatigue are not specifically designed for patients with IBD and none of them has undergone a complete validation process for IBD-related fatigue. Fatigue is more prevalent in patients with active disease and may improve or disappear when remission is reached. Far more complex is the persistence or onset of fatigue in quiescent IBD which presents in up to 40% of the patients. In this subgroup of patients, fatigue can be related to smoldering systemic inflammation, a poor sleep quality, anemia, nutritional deficiencies, or comorbidities. In most cases, however, no direct cause can be identified. The lack of knowledge on the mechanisms that drive fatigue in IBD hamper the development of specific drugs to treat the condition and only psychological support can be offered to the patient. Rodent models are indispensable to increase our understanding of the molecular pathways that lead to fatigue in chronic intestinal inflammation, and to develop novel therapies.
Collapse
|