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Skjellerudsveen BM, Omdal R, Hetta AK, Kvaløy JT, Aabakken L, Skoie IM, Grimstad T. Less, but not gone-gluten-free diet effects on fatigue in celiac disease: a prospective controlled study. Front Med (Lausanne) 2023; 10:1242512. [PMID: 37766922 PMCID: PMC10520960 DOI: 10.3389/fmed.2023.1242512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 08/28/2023] [Indexed: 09/29/2023] Open
Abstract
Introduction Fatigue is a frequent complaint in patients with celiac disease. A gluten-free diet is the only established treatment for celiac disease, but how this diet influences fatigue is uncertain. We aimed to investigate fatigue prevalence, severity, and associated factors in patients with celiac disease, at diagnosis and at 1 year after commencing a gluten-free diet. Methods 78 patients with serologically and histologically verified celiac disease, 78 age- and sex-matched healthy subjects. Primary endpoints were Fatigue Visual Analog Scale (fVAS), Fatigue Severity Scale (FSS), and inverted Vitality subscale of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36vs). Clinically relevant fatigue was defined as: FSS score ≥ 4, fVAS score ≥ 50 mm, or inverted SF-36vs score ≥ 65. Higher scores represented more fatigue. Results Fatigue was reduced after a 12-month gluten-free diet. Median scores changed from 3.8 (interquartile range [IQR]: 2.2 to 4.8) to 1.9 (IQR: 1.4 to 3.5) for FSS, from 44.5 (IQR: 18.8 to 66.0) to 15.5 (IQR: 7.8 to 43.3) for fVAS, and from 65 (IQR: 40 to 75) to 35 (IQR: 25 to 55) for inverted SF-36vs (p < 0.001 for all). Fatigue prevalence also declined after treatment. However, scores were significantly higher in patients compared to control subjects. Higher fatigue scores were associated with depression and pain, but not with signs of disease activity or nutritional deficiency. Conclusion At diagnosis, patients with celiac disease frequently had severe fatigue. Fatigue declined after a gluten-free diet, but it remained higher than that observed in healthy subjects. Clinical trial registration ClinicalTrials.gov, Identifier NCT01551563.
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Affiliation(s)
| | - Roald Omdal
- Department of Internal Medicine, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Anne Kristine Hetta
- Department of Internal Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Jan Terje Kvaløy
- Department of Mathematics and Physics, University of Stavanger, Stavanger, Norway
- Department of Research, Stavanger University Hospital, Stavanger, Norway
| | - Lars Aabakken
- Department of Transplantation Medicine, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Inger Marie Skoie
- Department of Dermatology, Stavanger University Hospital, Stavanger, Norway
| | - Tore Grimstad
- Department of Internal Medicine, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
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Iordache MM, Belu AM, Vlad SE, Aivaz KA, Dumitru A, Tocia C, Dumitru E. Calprotectin, Biomarker of Depression in Patients with Inflammatory Bowel Disease? MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1240. [PMID: 37512053 PMCID: PMC10383955 DOI: 10.3390/medicina59071240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/22/2023] [Accepted: 06/28/2023] [Indexed: 07/30/2023]
Abstract
Background and Objectives: Calprotectin is a marker for intestinal inflammation. Recent research suggests a link between inflammation and depression. This study assessed the association between the levels of calprotectin in patients from South-Eastern Europe and the severity of depression, anxiety, and quality of life. Materials and Methods: This cross-sectional study included 30 confirmed patients with Crohn's disease (CD) and ulcerative colitis (UC) who were assessed using clinical interviews for determining the severities of mental disorders (i.e., depression severity-PHQ-9, anxiety-GAD-7) and the quality of life (EQ-5D). Stool samples were collected from all participants for measuring their levels of calprotectin. Results: The level of calprotectin is correlated with PHQ-9 (ρ = 0.416, p = 0.022) and EQ-5D (ρ = -0.304, p = 0.033) but not with GAD 7 (ρ = 0.059, p = 0.379). Calprotectin levels in patients with mild, moderate, and moderately severe depression were significantly higher than in patients with minimal depression (198 µg/g vs. 66,9 µg/g, p = 0.04). Calprotectin level was corelated with the following depressive symptoms: autolytic ideation (ρ = 0.557, p = 0.001), fatigue (ρ = 0.514, p = 0.002), slow movement (ρ = 0.490, p = 0.003), and sleep disorders (ρ = 0.403, p = 0.014). Calprotectin was an independent predictor of depression with an odds ratio of 1.01 (95%: 1.002-1.03, p < 0.01). An ROC analysis showed that a level of calprotectin of 131 µg/g or higher has a sensitivity of 82%, a specificity of 61%, and an accuracy of 70% for predicting depression. In this study, no significant correlations were found between calprotectin level and anxiety. Conclusions: Calprotectin levels are associated with the severity of depression, and checking for a calprotectin level of 131 µg/g or higher may be a potential accessible screening test for depression in patients with inflammatory bowel disease.
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Affiliation(s)
- Miorita Melina Iordache
- Faculty of Medicine, Ovidius University of Constanta, 1 Universitatii Alley, 900470 Constanta, Romania
- Prof. Alexandru Obregia Psychiatry Hospital, 10 Berceni Str., 041914 Bucharest, Romania
| | - Anca Mihaela Belu
- Faculty of Medicine, Ovidius University of Constanta, 1 Universitatii Alley, 900470 Constanta, Romania
- "St. Apostol Andrew" Emergency County Hospital, 145 Tomis Blvd., 900591 Constanta, Romania
| | - Sabina E Vlad
- Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology-CEDMOG, "Ovidius" University of Constanta, 900591 Constanta, Romania
| | - Kamer Ainur Aivaz
- Faculty of Economics, Ovidius University of Constanta, 1 Universitatii Street, 900470 Constanta, Romania
| | - Andrei Dumitru
- Faculty of Medicine, Ovidius University of Constanta, 1 Universitatii Alley, 900470 Constanta, Romania
- "St. Apostol Andrew" Emergency County Hospital, 145 Tomis Blvd., 900591 Constanta, Romania
| | - Cristina Tocia
- Faculty of Medicine, Ovidius University of Constanta, 1 Universitatii Alley, 900470 Constanta, Romania
- "St. Apostol Andrew" Emergency County Hospital, 145 Tomis Blvd., 900591 Constanta, Romania
| | - Eugen Dumitru
- Faculty of Medicine, Ovidius University of Constanta, 1 Universitatii Alley, 900470 Constanta, Romania
- "St. Apostol Andrew" Emergency County Hospital, 145 Tomis Blvd., 900591 Constanta, Romania
- Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology-CEDMOG, "Ovidius" University of Constanta, 900591 Constanta, Romania
- Academy of Romanian Scientists, 3 Ilfov Street, 050045 Bucharest, Romania
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3
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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.
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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
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4
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Zhao E, Yu Q, Ali AI, Mu Y, Shi Y, Zhu L. Effects of standard treatments on depressive/anxiety symptoms in patients with inflammatory bowel disease: A systematic review and meta-analysis. Gen Hosp Psychiatry 2022; 74:118-125. [PMID: 32563588 DOI: 10.1016/j.genhosppsych.2020.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE A combination of inflammatory bowel disease (IBD) and psychological comorbidities can influence the natural course of IBD. A systematic review and meta-analysis was performed to examine whether a standard IBD medical therapy without any antipsychotic intervention has beneficial effects on depression/anxiety in IBD patients. METHODS PubMed and Web of Science databases were systematically searched for related literature from their inception to March 2020. The random-effects model was used to calculate the standardized mean difference (SMD). A total of 16 eligible studies were included in the present meta-analysis. RESULTS Compared with baseline assessments, IBD patients with standard IBD medication had significantly reduced depression assessment scores (pooled SMD = 0.500; 95% confidence interval: 0.207, 0.793; P = 0.001). These results were obtained without any psychological interventions. Additionally, no significant differences in anxiety-related scores were detected between the baseline assessments and the end of therapy assessments (pooled SMD = 0.083; 95% confidence interval: -0.120, 0.285; P = 0.425). The meta-regression and subgroup analyses revealed that differences in assessment tools and medications might be the main source of heterogeneity. CONCLUSION Standard IBD treatments can significantly alleviate the depressive symptoms in IBD patients. However, more studies are needed to analyze this association.
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Affiliation(s)
- En Zhao
- Department of Gastroenterology, Affiliated Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, China
| | - Qian Yu
- Department of Gastroenterology, Affiliated Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, China
| | - Abdoulaye Idriss Ali
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, China
| | - Yulu Mu
- Department of Vasculocardiology, Tanghe County People's Hospital, Nanyang, Henan 473400, China
| | - Yachen Shi
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, China
| | - Lin Zhu
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, China.
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5
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Kamp KJ, Clark-Snustad K, Barahimi M, Lee S. Relationship Between Endoscopic and Clinical Disease Activity With Fatigue in Inflammatory Bowel Disease. Gastroenterol Nurs 2022; 45:21-28. [PMID: 35020629 PMCID: PMC8820259 DOI: 10.1097/sga.0000000000000600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 02/01/2021] [Indexed: 01/03/2023] Open
Abstract
Fatigue is a prevalent symptom among individuals with inflammatory bowel disease. Yet, few studies have examined the relationship between fatigue and endoscopic disease activity. A retrospective chart review was conducted to determine the prevalence of fatigue based on endoscopic inflammation and clinical disease activity and describe the factors associated with fatigue among adults with inflammatory bowel disease. One hundred sixty patients were included. The majority had Crohn disease (72.5%), with an average age of 40.5 years. Sixty-one percent reported fatigue. Both endoscopic (p = .03) and clinical disease activities (p = .001) were significantly associated with fatigue. Among participants reporting fatigue, 52% had inactive disease and 48% had active disease based on endoscopy whereas 63% reported clinically active disease and 37% reported clinically inactive disease. In the multivariate regression model, clinical disease activity (odds ratio [OR] = 8.5; 95% CI [3.9, 18.6]) and anxiety (OR = 2.8; 95% CI [1.0, 7.6]) were significantly associated with fatigue. The prevalence of fatigue is high among individuals with active and inactive disease. Clinical disease activity and anxiety, but not endoscopic disease activity, were associated with fatigue.
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Affiliation(s)
- Kendra J Kamp
- Kendra J. Kamp, PhD, RN, is a post-doctoral fellow at Division of Gastroenterology, University of Washington, Seattle, WA
- Kindra Clark-Snustad, DNP, ARNP, is a teaching associate at Division of Gastroenterology, University of Washington, Seattle, WA
- Mitra Barahimi, MD, is a clinical assistant professor at Division of Gastroenterology, University of Washington, Seattle, WA
- Scott Lee, MD, is an associate professor at Division of Gastroenterology, University of Washington, Seattle, WA
- Kindra Clark-Snustad has served as a consultant for Pfizer. Scott D. Lee has received grant support from AbbVie, UCB Pharma, Janssen, Salix, Takeda, Calgene, Arena, and AbGenomics and has served as a consultant for UCB Pharma, Cornerstones Health, Janssen, Eli Lilly and Company, Celgene, KCRN Research, LLC, Boehringer Ingelheim Pharmaceuticals, Bristol-Myers Squibb, Applied Molecular Transport, Arena, Celltrion Healthcare, Samsung Bioepis Co, and Bridge Biotherapeutics. The other authors have no conflicts of interest to disclose
| | - Kindra Clark-Snustad
- Kendra J. Kamp, PhD, RN, is a post-doctoral fellow at Division of Gastroenterology, University of Washington, Seattle, WA
- Kindra Clark-Snustad, DNP, ARNP, is a teaching associate at Division of Gastroenterology, University of Washington, Seattle, WA
- Mitra Barahimi, MD, is a clinical assistant professor at Division of Gastroenterology, University of Washington, Seattle, WA
- Scott Lee, MD, is an associate professor at Division of Gastroenterology, University of Washington, Seattle, WA
- Kindra Clark-Snustad has served as a consultant for Pfizer. Scott D. Lee has received grant support from AbbVie, UCB Pharma, Janssen, Salix, Takeda, Calgene, Arena, and AbGenomics and has served as a consultant for UCB Pharma, Cornerstones Health, Janssen, Eli Lilly and Company, Celgene, KCRN Research, LLC, Boehringer Ingelheim Pharmaceuticals, Bristol-Myers Squibb, Applied Molecular Transport, Arena, Celltrion Healthcare, Samsung Bioepis Co, and Bridge Biotherapeutics. The other authors have no conflicts of interest to disclose
| | - Mitra Barahimi
- Kendra J. Kamp, PhD, RN, is a post-doctoral fellow at Division of Gastroenterology, University of Washington, Seattle, WA
- Kindra Clark-Snustad, DNP, ARNP, is a teaching associate at Division of Gastroenterology, University of Washington, Seattle, WA
- Mitra Barahimi, MD, is a clinical assistant professor at Division of Gastroenterology, University of Washington, Seattle, WA
- Scott Lee, MD, is an associate professor at Division of Gastroenterology, University of Washington, Seattle, WA
- Kindra Clark-Snustad has served as a consultant for Pfizer. Scott D. Lee has received grant support from AbbVie, UCB Pharma, Janssen, Salix, Takeda, Calgene, Arena, and AbGenomics and has served as a consultant for UCB Pharma, Cornerstones Health, Janssen, Eli Lilly and Company, Celgene, KCRN Research, LLC, Boehringer Ingelheim Pharmaceuticals, Bristol-Myers Squibb, Applied Molecular Transport, Arena, Celltrion Healthcare, Samsung Bioepis Co, and Bridge Biotherapeutics. The other authors have no conflicts of interest to disclose
| | - Scott Lee
- Kendra J. Kamp, PhD, RN, is a post-doctoral fellow at Division of Gastroenterology, University of Washington, Seattle, WA
- Kindra Clark-Snustad, DNP, ARNP, is a teaching associate at Division of Gastroenterology, University of Washington, Seattle, WA
- Mitra Barahimi, MD, is a clinical assistant professor at Division of Gastroenterology, University of Washington, Seattle, WA
- Scott Lee, MD, is an associate professor at Division of Gastroenterology, University of Washington, Seattle, WA
- Kindra Clark-Snustad has served as a consultant for Pfizer. Scott D. Lee has received grant support from AbbVie, UCB Pharma, Janssen, Salix, Takeda, Calgene, Arena, and AbGenomics and has served as a consultant for UCB Pharma, Cornerstones Health, Janssen, Eli Lilly and Company, Celgene, KCRN Research, LLC, Boehringer Ingelheim Pharmaceuticals, Bristol-Myers Squibb, Applied Molecular Transport, Arena, Celltrion Healthcare, Samsung Bioepis Co, and Bridge Biotherapeutics. The other authors have no conflicts of interest to disclose
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6
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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.
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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
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7
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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: 55] [Impact Index Per Article: 13.8] [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.
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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.
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8
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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
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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
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9
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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.
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10
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Artom M, Czuber-Dochan W, Sturt J, Norton C. Cognitive behavioural therapy for the management of inflammatory bowel disease-fatigue with a nested qualitative element: study protocol for a randomised controlled trial. Trials 2017; 18:213. [PMID: 28490349 PMCID: PMC5425996 DOI: 10.1186/s13063-017-1926-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 04/03/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Fatigue is one of the most prevalent and burdensome symptoms for patients with inflammatory bowel disease (IBD). Although fatigue increases during periods of inflammation, for some patients it persists when disease is in remission. Compared to other long-term conditions where fatigue has been extensively researched, optimal management of fatigue in patients with IBD is unknown and fatigue has rarely been the primary outcome in intervention studies. To date, interventions for the management of IBD-fatigue are sparse, have short-term effects and have not been implemented within the existing health system. There is a need to integrate current best evidence across different conditions, patient experience and clinical expertise in order to develop interventions for IBD-fatigue management that are feasible and effective. Modifying an existing intervention for patients with multiple sclerosis, this study aims to assess the feasibility and initial estimates of efficacy of a cognitive behavioural therapy (CBT) intervention for the management of fatigue in patients with IBD. METHODS The study will be a two-arm pilot randomised controlled trial. Patients will be recruited from one outpatient IBD clinic and randomised individually to either: Group 1 (CBT manual for the management of fatigue, one 60-min session and seven 30-min telephone/Skype sessions with a therapist over an eight-week period); or Group 2 (fatigue information sheet to use without therapist help). Self-reported IBD-fatigue (Inflammatory Bowel Disease-Fatigue Scale) and IBD-quality of life (United Kingdom Inflammatory Bowel Disease Questionnaire) and self-reported disease activity will be collected at baseline, three, six and 12 months post randomisation. Illness perceptions, daytime sleepiness, anxiety and depression explanatory variables will be collected only at three months post randomisation. Clinical and sociodemographic data will be retrieved from the patients' medical notes. A nested qualitative study will evaluate patient and therapist experience, and healthcare professionals' perceptions of the intervention. DISCUSSION The study will provide evidence of the feasibility and initial estimates of efficacy of a CBT intervention for the management of fatigue in patients with IBD. Quantitative and qualitative findings from the study will contribute to the development and implementation of a large-scale randomised controlled trial assessing the efficacy of CBT interventions for IBD-fatigue. TRIAL REGISTRATION ISRCTN Registry, ISRCTN17917944 . Registered on 2 September 2016.
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Affiliation(s)
- Micol Artom
- King’s College London, Florence Nightingale Faculty of Nursing & Midwifery, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA UK
| | - Wladyslawa Czuber-Dochan
- King’s College London, Florence Nightingale Faculty of Nursing & Midwifery, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA UK
| | - Jackie Sturt
- King’s College London, Florence Nightingale Faculty of Nursing & Midwifery, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA UK
| | - Christine Norton
- King’s College London, Florence Nightingale Faculty of Nursing & Midwifery, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA UK
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