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Barnes A, Bryant RV, Mukherjee S, Andrews JM, Bampton P, Fraser RJ, Mountifield R. Depression influences fatigue in inflammatory bowel disease amongst other factors: a structural modelling approach. Therap Adv Gastroenterol 2024; 17:17562848241271987. [PMID: 39228998 PMCID: PMC11369876 DOI: 10.1177/17562848241271987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 07/02/2024] [Indexed: 09/05/2024] Open
Abstract
Objectives Fatigue is common in people with inflammatory bowel disease (IBD) and is associated with IBD activity, sleep disturbance, anxiety and depression. The relative contribution of these factors to fatigue is unclear. This study aimed to investigate the relationship between fatigue and these factors through a novel approach using structural equation modelling. Design Online questionnaire circulated via three tertiary IBD centres and Crohn's Colitis Australia. Methods Fatigue was assessed using the Functional assessment of chronic illness measurement system fatigue subscale. Validated measures of sleep, anxiety, depression and IBD activity were included. Following correlation analyses, a structural equation model was developed for the outcome of the fatigue score. Direct and indirect effects were calculated. Results There were 630 complete responses to the online questionnaire. The median age of respondents was 41 with the majority female and over half (52%) on biologic medication. Structural equation models for Crohn's disease and ulcerative colitis demonstrated a good fit. In Crohn's disease, the relationship between IBD activity and fatigue was mostly mediated indirectly through the influence of IBD activity on sleep, anxiety and primarily depression. Sleep quality mediated the influence of IBD activity and the indirect effects of depression on fatigue, but not anxiety. Unlike in Crohn's disease, the direct influence of IBD activity on fatigue in ulcerative colitis was non-negligible, although remained of lesser magnitude than the indirect effect of IBD activity on fatigue. Depression was the primary indirect mediator of the influence of IBD activity on fatigue in ulcerative colitis. Conclusion In Crohn's disease, IBD activity leads to fatigue through its influence on sleep quality and mental health. The data suggest treatment of clinically significant depression, in both ulcerative colitis and Crohn's disease, may result in the largest decline in fatigue score compared to other variables. Treatment algorithms for fatigue should consider depression a priority.
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Affiliation(s)
- Alex Barnes
- Department of Gastroenterology, Flinders Medical Centre, Southern Adelaide Local Health Network, Flinders Drive, Bedford Park, SA 5042, Australia
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Robert V. Bryant
- School of Medicine, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
- Department of Gastroenterology, Queen Elizabeth Hospital, Woodville, SA, Australia
| | - Sutapa Mukherjee
- Adelaide Institute for Sleep Health, Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
- Department of Respiratory and Sleep Medicine, Flinders Medical Centre, Southern Adelaide Local Health Network, Bedford Park, SA, Australia
| | - Jane M. Andrews
- Inflammatory Bowel Disease Service, Department of Gastroenterology and Hepatology, Central Adelaide Local Health Network, Royal Adelaide Hospital, Adelaide, SA, Australia
- School of Medicine, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Peter Bampton
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Robert J. Fraser
- Department of Gastroenterology, Flinders Medical Centre, Southern Adelaide Local Health Network, Bedford Park, SA, Australia
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Réme Mountifield
- Department of Gastroenterology, Flinders Medical Centre, Southern Adelaide Local Health Network, Bedford Park, SA, Australia
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
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Barnes A, Toson B, Bryant RV, Mukherjee S, Andrews JM, Spizzo P, Mountifield R. Latent profiles of fatigue in inflammatory bowel disease. BMC Gastroenterol 2024; 24:148. [PMID: 38689277 PMCID: PMC11061964 DOI: 10.1186/s12876-024-03239-2] [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: 11/15/2023] [Accepted: 04/24/2024] [Indexed: 05/02/2024] Open
Abstract
INTRODUCTION Fatigue is prevalent in people with inflammatory bowel disease (IBD) and has been associated with IBD activity, sleep quality, depression, and anxiety. This study aimed to identify fatigue profiles or clusters through latent profile analysis. METHODS An online questionnaire was administered through three tertiary IBD centres, social media and through Crohn's Colitis Australia. Fatigue was assessed via the Functional assessment of chronic illness measurement system fatigue subscale (FACIT-F), a validated assessment of fatigue and its severity. Validated measures of anxiety, depression, IBD activity and sleep quality were also included. Latent profile analysis was performed including fatigue, sleep quality, active IBD, and depression and anxiety. The relationships between profiles and IBD and demographic data were investigated. RESULTS In a cohort of 535 respondents, 77% were female, the median age was 41 years (range 32-52 years), and the majority had Crohn's disease (62%). Severe fatigue was seen in 62%. Latent profile analysis identified four distinct profiles differing by fatigue score - low fatigue, at-risk profile, active IBD, and a poor mental health profile. Female gender, obesity and opioid usage were associated with higher risk of being in the active IBD and poor mental health profile. Age over 40 was associated with lower risk of being in the poor mental health profile. CONCLUSION Latent profile analysis identifies four classes of fatigue in an IBD cohort with associations with specific risk factors for fatigue along with specific IBD and demographic attributes. This has implications for the classification of fatigue in IBD and treatment algorithms.
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Affiliation(s)
- Alex Barnes
- Department of Gastroenterology, Southern Adelaide Local Health Network (SALHN), Flinders Medical Centre, Flinders Drive, Bedford Park, 5042, SA, Australia.
- College of medicine and public health, Flinders University, Bedford Park, SA, Australia.
| | - Barbara Toson
- Adelaide Institute for Sleep Health, Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - R V Bryant
- Department of Gastroenterology, Queen Elizabeth Hospital, Woodville, SA, Australia
- School of Medicine, Faculty of Health & Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Sutapa Mukherjee
- Adelaide Institute for Sleep Health, Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
- Department of Respiratory and Sleep Medicine, Southern Adelaide Local Health Network (SALHN) Flinders Medical Centre, Bedford Park, SA, Australia
| | - Jane M Andrews
- School of Medicine, Faculty of Health & Medical Sciences, University of Adelaide, Adelaide, SA, Australia
- Inflammatory Bowel Disease Service, Department of Gastroenterology and Hepatology, (CAHLN) Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Paul Spizzo
- Department of Gastroenterology, Southern Adelaide Local Health Network (SALHN), Flinders Medical Centre, Flinders Drive, Bedford Park, 5042, SA, Australia
| | - Réme Mountifield
- Department of Gastroenterology, Southern Adelaide Local Health Network (SALHN), Flinders Medical Centre, Flinders Drive, Bedford Park, 5042, SA, Australia
- College of medicine and public health, Flinders University, Bedford Park, SA, Australia
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Gordon H, Burisch J, Ellul P, Karmiris K, Katsanos K, Allocca M, Bamias G, Barreiro-de Acosta M, Braithwaite T, Greuter T, Harwood C, Juillerat P, Lobaton T, Müller-Ladner U, Noor N, Pellino G, Savarino E, Schramm C, Soriano A, Michael Stein J, Uzzan M, van Rheenen PF, Vavricka SR, Vecchi M, Zuily S, Kucharzik T. ECCO Guidelines on Extraintestinal Manifestations in Inflammatory Bowel Disease. J Crohns Colitis 2024; 18:1-37. [PMID: 37351850 DOI: 10.1093/ecco-jcc/jjad108] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Indexed: 06/24/2023]
Affiliation(s)
- Hannah Gordon
- Department of Gastroenterology, Barts Health NHS Trust, London, Centre for Immunobiology, Blizard Institute, Faculty of Medicine, Barts & The London Medical School, Queen Mary University of London, UK
| | - Johan Burisch
- Gastrounit, medical division, Hvidovre Hospital, University of Copenhagen, Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Hvidovre Hospital, University of Copenhagen, Denmark
| | - Pierre Ellul
- Department of Medicine, Division of Gastroenterology, Mater Dei Hospital, Msida, Malta
| | | | - Konstantinos Katsanos
- Department of Gastroenterology and Hepatology, Division of Internal Medicine, University and Medical School of Ioannina, Ioannina, Greece
| | - Mariangela Allocca
- Department of Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and University Vita-Salute San Raffaele, Milan, Italy
| | - Giorgos Bamias
- GI Unit, 3rd Academic Department of Internal Medicine, National and Kapodistrian University of Athens, Sotiria Hospital, Athens, Greece
| | - Manuel Barreiro-de Acosta
- University Hospital Santiago De Compostela CHUS, Department of Gastroenterology - IBD Unit, Santiago De Compostela, Spain
| | - Tasanee Braithwaite
- School of Immunology and Microbiology, King's College London, The Medical Eye Unit, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Thomas Greuter
- Division of Gastroenterology and Hepatology, GZO - Zurich Regional Health Center, Wetzikon, Division of Gastroenterology and Hepatology, University Hospital Lausanne - CHUV, Lausanne, Switzerland; Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Catherine Harwood
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London; Department of Dermatology, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Pascal Juillerat
- Gastroenterology, Clinic for Visceral Surgery and Medicine, Bern University Hospital, Bern, Switzerland; Crohn and Colitis Center, Gastro-entérologie Beaulieu SA, Lausanne, Switzerland
| | - Triana Lobaton
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent; Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium
| | - Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Campus Kerckhoff, Justus Liebig University Giessen, Bad Nauheim, Germany
| | - Nurulamin Noor
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Gianluca Pellino
- Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona UAB, Barcelona, Spain; Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania 'Luigi Vanvitelli', Naples, Italy
| | - Edoardo Savarino
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy; Gastroenterology Unit, Azienda Ospedale Università di Padova, Padua, Italy
| | - Christoph Schramm
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Martin Zeitz Center for Rare Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Hamburg Center for Translational Immunology (HCTI), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alessandra Soriano
- Gastroenterology Division and IBD Center, Internal Medicine Department, Azienda Unità Sanitaria Locale - IRCCS, 42122 Reggio Emilia, Italy
| | - Jürgen Michael Stein
- Interdisciplinary Crohn Colitis Centre Rhein-Main, Frankfurt/Main, Department of Gastroenterology and Clinical Nutrition, DGD Clinics Sachsenhausen, Frankfurt/Main, Germany
| | - Mathieu Uzzan
- Department of Gastroenterology, Hôpital Henri Mondor, APHP, Créteil, France
| | - Patrick F van Rheenen
- Department of Paediatric Gastroenterology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Stephan R Vavricka
- Department of Gastroenterology and Hepatology, University Hospital, Zurich, Switzerland
| | - Maurizio Vecchi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Stephane Zuily
- Vascular Medicine Division and French Referral Center for Rare Auto-Immune Diseases, Université de Lorraine, INSERM, DCAC and CHRU-Nancy, Nancy, France
| | - Torsten Kucharzik
- Department of Gastroenterology, Lüneburg Hospital, University of Münster, Lüneburg, Germany
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Barnes A, Andrews JM, Mukherjee S, Bryant RV, Bampton P, Fraser RJ, Mountifield R. Insomnia is common in inflammatory bowel disease (IBD) and is associated with mental health conditions as well as IBD activity. Intest Res 2024; 22:104-114. [PMID: 37904322 PMCID: PMC10850702 DOI: 10.5217/ir.2023.00028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 07/20/2023] [Accepted: 08/22/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND/AIMS Insomnia is common in people with chronic medical conditions, such as inflammatory bowel disease (IBD), and is readily treatable through cognitive behavioral therapy for insomnia. This study aimed to describe the associations with insomnia in people with IBD and its relationship to IBD-related disability. METHODS An online questionnaire was administered through 3 tertiary IBD centers, social media, and Crohn's Colitis Australia. The questionnaire included the Insomnia Severity Index (ISI), a validated assessment of insomnia. Measures of anxiety, depression, physical activity, and disability were also included. IBD activity was assessed using validated patient reported scores. A multivariate model was constructed for clinically significant insomnia and ISI scores. Subpopulations of Crohn's disease and ulcerative colitis were considered. RESULTS In a cohort of 670 respondents the median age was 41 years (range, 32-70 years), with the majority female (78.4%), the majority had Crohn's disease (57.3%). Increasingly severe disability was associated with worse insomnia score. Clinically significant insomnia was associated with clinically active IBD, abdominal pain, anxiety, and depression, in a multivariate model. In an ulcerative colitis population, Simple Clinical Colitis Activity Index components of general well-being and urgency were associated with worse ISI score in a model including depression and anxiety. In those with Crohn's disease, the multivariate model included Harvey Bradshaw Index score in addition to depression and anxiety. CONCLUSIONS Insomnia is common in people with IBD and is associated with increased disability. Abdominal pain and mental health conditions should prompt consideration for screening for insomnia and referral for cognitive behavioral therapy for insomnia.
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Affiliation(s)
- Alex Barnes
- Department of Gastroenterology, Southern Adelaide Local Health Network (SALHN) Flinders Medical Centre, Bedford Park, Australia
- Adelaide Institute for Sleep Health, Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, Australia
| | - Jane M Andrews
- Inflammatory Bowel Disease Service, Department of Gastroenterology and Hepatology, Central Adelaide Local Health Network (CALHN) Royal Adelaide Hospital, Adelaide, Australia
- School of Medicine, Faculty of Health & Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Sutapa Mukherjee
- Adelaide Institute for Sleep Health, Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, Australia
- Department of Respiratory and Sleep Medicine, Southern Adelaide Local Health Network (SALHN) Flinders Medical Centre, Bedford Park, Australia
| | - Robert V Bryant
- School of Medicine, Faculty of Health & Medical Sciences, University of Adelaide, Adelaide, Australia
- Department of Gastroenterology, Queen Elizabeth Hospital, Woodville, Australia
| | - Peter Bampton
- Adelaide Institute for Sleep Health, Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, Australia
| | - Robert J. Fraser
- Department of Gastroenterology, Southern Adelaide Local Health Network (SALHN) Flinders Medical Centre, Bedford Park, Australia
- Adelaide Institute for Sleep Health, Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, Australia
| | - Réme Mountifield
- Department of Gastroenterology, Southern Adelaide Local Health Network (SALHN) Flinders Medical Centre, Bedford Park, Australia
- Adelaide Institute for Sleep Health, Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, Australia
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5
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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.
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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
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6
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Włodarczyk M, Makaro A, Prusisz M, Włodarczyk J, Nowocień M, Maryńczak K, Fichna J, Dziki Ł. The Role of Chronic Fatigue in Patients with Crohn's Disease. Life (Basel) 2023; 13:1692. [PMID: 37629549 PMCID: PMC10455565 DOI: 10.3390/life13081692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 07/29/2023] [Indexed: 08/27/2023] Open
Abstract
Crohn's disease (CD) is a chronic, relapsing disorder belonging to inflammatory bowel diseases (IBD). It is manifested by relapsing transmural inflammation found in any segment of the gastrointestinal tract. Chronic fatigue is a common and underrecognized symptom of CD for which the prevalence is much higher in the population of CD patients compared to the healthy population. It stems from an intricate web of interactions between various risk factors, and its pathophysiology is still not fully understood. The implementation of routine screening and a holistic, multidisciplinary approach involving psychological support may be crucial in the management of CD patients with chronic fatigue. There is currently no single intervention aimed at decreasing fatigue alone, and its treatment is especially difficult in patients with fatigue persisting despite clinical and endoscopic remission. Extensive research is still needed in order to be able to predict, prevent, identify, and ultimately treat fatigue associated with CD. The aim of this review is to summarize the knowledge on the etiology, diagnosis, and treatment of chronic fatigue in CD patients.
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Affiliation(s)
- Marcin Włodarczyk
- Department of General and Oncological, Medical University of Lodz, Pomorska 251, PL 90-213 Lodz, Poland
| | - Adam Makaro
- Department of General and Oncological, Medical University of Lodz, Pomorska 251, PL 90-213 Lodz, Poland
- Department of Biochemistry, Medical University of Lodz, Mazowiecka 5, PL 92-215 Lodz, Poland
| | - Mateusz Prusisz
- Department of General and Oncological, Medical University of Lodz, Pomorska 251, PL 90-213 Lodz, Poland
| | - Jakub Włodarczyk
- Department of General and Oncological, Medical University of Lodz, Pomorska 251, PL 90-213 Lodz, Poland
- Department of Biochemistry, Medical University of Lodz, Mazowiecka 5, PL 92-215 Lodz, Poland
| | - Marta Nowocień
- Department of General and Oncological, Medical University of Lodz, Pomorska 251, PL 90-213 Lodz, Poland
| | - Kasper Maryńczak
- Department of General and Oncological, Medical University of Lodz, Pomorska 251, PL 90-213 Lodz, Poland
| | - Jakub Fichna
- Department of Biochemistry, Medical University of Lodz, Mazowiecka 5, PL 92-215 Lodz, Poland
| | - Łukasz Dziki
- Department of General and Oncological, Medical University of Lodz, Pomorska 251, PL 90-213 Lodz, Poland
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Johansen I, Småstuen MC, Løkkeberg ST, Kristensen VA, Høivik ML, Lund C, Olsen B, Strande V, Huppertz-Hauss G, Aabrekk TB, Bengtson MB, Ricanek P, Detlie TE, Frigstad SO, Jelsness-Jørgensen LP, Opheim R. Symptoms and symptom clusters in patients newly diagnosed with inflammatory bowel disease: results from the IBSEN III Study. BMC Gastroenterol 2023; 23:255. [PMID: 37501083 PMCID: PMC10373240 DOI: 10.1186/s12876-023-02889-y] [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: 02/09/2023] [Accepted: 07/17/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Patients with inflammatory bowel disease report multiple symptoms, but the relationships among co-occurring symptoms are poorly understood. This study aimed to examine the prevalence of symptoms and explore symptom clusters and possible associations between symptom clusters and socio-demographic and clinical variables in patients newly diagnosed with inflammatory bowel disease. METHODS The IBSEN III study is a prospective population-based inception cohort of patients with inflammatory bowel disease. This study used patient data from the three largest hospitals in the study catchment area. The Memorial Symptom Assessment Scale was used to assess the prevalence of symptoms. Symptom clusters were identified using principal component analysis. Possible associations between socio-demographic and clinical variables and symptom cluster membership were estimated using regression analysis. RESULTS Of the 573 patients (age, ≥18 years) diagnosed with inflammatory bowel disease, 350 (61.1%) completed the questionnaire (responders). Eleven symptoms were reported by >50% of the responders. The three most prevalent symptoms were bloating (84%), drowsiness (81%), and lack of energy (81%). Three symptom clusters were identified: psychological (56% of the patients), impaired energy (28%), and physical (16%) clusters. Multinomial regression analysis revealed that vitamin D deficiency was significantly associated with the impaired energy cluster (odds ratio=2.49, 95% confidence interval [1.00-6.2], p=0.05). CONCLUSIONS We found high symptom prevalence in patients newly diagnosed with inflammatory bowel disease. Three distinct symptom clusters were identified, and the psychological cluster includes >50% of the patients. Vitamin D deficiency is the only factor associated with cluster membership, namely the impaired energy cluster.
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Affiliation(s)
- Ingunn Johansen
- Department of Health, Welfare and Organization, Østfold University College, Fredrikstad, Norway
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | | | - Stine Torp Løkkeberg
- Department of Health, Welfare and Organization, Østfold University College, Fredrikstad, Norway
| | | | - Marte Lie Høivik
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Charlotte Lund
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Bjørn Olsen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Gastroenterology, Telemark Hospital Trust, Skien, Norway
| | - Vibeke Strande
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Unger-Vetlesen Institute, Lovisenberg Diaconal Hospital, Oslo, Norway
- Department of Gastroenterology, Lovisenberg Diaconal Hospital, Oslo, Norway
| | | | - Tone Bergene Aabrekk
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Gastroenterology, Vestfold Hospital Trust, Tønsberg, Norway
| | - May-Bente Bengtson
- Department of Gastroenterology, Vestfold Hospital Trust, Tønsberg, Norway
| | - Petr Ricanek
- Department of Gastroenterology, Akershus University Hospital, Lørenskog, Norway
| | - Trond Espen Detlie
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Gastroenterology, Akershus University Hospital, Lørenskog, Norway
| | - Svein Oskar Frigstad
- Department of Medicine, Vestre Viken Hospital Trust, Baerum Hospital, Baerum, Norway
| | - Lars-Petter Jelsness-Jørgensen
- Department of Health, Welfare and Organization, Østfold University College, Fredrikstad, Norway
- Department of Gastroenterology, Østfold Hospital Trust, Fredrikstad, Norway
| | - Randi Opheim
- Institute of Health and Society, University of Oslo, Oslo, Norway
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
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Stroie T, Preda C, Meianu C, Istrătescu D, Manuc M, Croitoru A, Gheorghe L, Gheorghe C, Diculescu M. Fatigue Is Associated with Anxiety and Lower Health-Related Quality of Life in Patients with Inflammatory Bowel Disease in Remission. Medicina (B Aires) 2023; 59:medicina59030532. [PMID: 36984533 PMCID: PMC10058711 DOI: 10.3390/medicina59030532] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 03/04/2023] [Accepted: 03/07/2023] [Indexed: 03/11/2023] Open
Abstract
Background and Objectives: Inflammatory bowel diseases (IBD) are chronic conditions with an unpredictable course and a remitting–relapsing evolution. Fatigue is a frequent complaint in patients with IBD, affecting approximately half of the newly diagnosed patients with IBD. The aim of this study was to analyze fatigue in patients with IBD in remission. Materials and Methods: One hundred nineteen consecutive outpatients diagnosed with IBD for over 3 months that were in corticosteroid-free clinical and biochemical remission at the time of assessment were included in this cross-sectional study. Out of them, 72 (60.5%) were male; the median age was 39 years (IQR 30–47). Seventy-seven patients (64.7%) were diagnosed with Crohn’s disease and forty-two (35.3%) with ulcerative colitis, with a median disease duration of 6 years (IQR 2–10). Fatigue, health-related quality of life (HR-QoL), anxiety and depression were evaluated using the following self-administered questionnaires: FACIT Fatigue, IBDQ 32 and HADS. Results: The mean FACIT-Fatigue score was 41.6 (SD ± 8.62), and 38.7% of patients were revealed as experiencing fatigue when a cut-off value of 40 points was used. The mean IBDQ 32 score was 189.4 (SD ± 24.1). Symptoms of anxiety and depression were detected in 37% and 21% of the patients, respectively. In the multivariate analysis, fatigue was significantly associated with lower HR-QoL (OR 2.21, 95% CI: 1.42–3.44, p < 0.001), symptoms of anxiety (OR 5.04, 95% CI: 1.20–21.22, p = 0.008), female sex (OR 3.32, 95% CI: 1.02–10.76, p = 0.04) and longer disease duration (OR 1.13, 95% CI: 1.01–1.27, p = 0.04). Conclusions: Fatigue is highly prevalent even in patients with inactive IBD and is correlated with lower HR-QoL and anxiety, as well as with clinical factors such as longer disease duration and female sex.
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Affiliation(s)
- Tudor Stroie
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Gastroenterology Department, Fundeni Clinical Institute, 022328 Bucharest, Romania
- Correspondence:
| | - Carmen Preda
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Gastroenterology Department, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Corina Meianu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Gastroenterology Department, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Doina Istrătescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Gastroenterology Department, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Mircea Manuc
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Gastroenterology Department, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Adina Croitoru
- Faculty of Medicine, Titu Maiorescu University, 040441 Bucharest, Romania
- Oncology Department, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Liana Gheorghe
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Gastroenterology Department, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Cristian Gheorghe
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Gastroenterology Department, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Mircea Diculescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Gastroenterology Department, Fundeni Clinical Institute, 022328 Bucharest, Romania
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9
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Tulewicz-Marti E, Szwarc P, Więcek M, Lewandowski K, Korcz T, Cicha M, Rydzewska G. Effect of Intravenous Iron Administration on Bone Mineral and Iron Homeostasis in Patients with Inflammatory Bowel Disease—Results of a Prospective Single-Centre Study. J Pers Med 2023; 13:jpm13030458. [PMID: 36983640 PMCID: PMC10056873 DOI: 10.3390/jpm13030458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/23/2023] [Accepted: 02/28/2023] [Indexed: 03/05/2023] Open
Abstract
Introduction: Anaemia and bone metabolism alterations are common in inflammatory bowel disease (IBD), which is a heterogeneous group of diseases that include Crohn’s disease (CD) and ulcerative colitis (UC) with a rich intestinal and extraintestinal symptomatology. All these make the diagnostic procedures complicated and difficult. Purpose and scope: The aim of this study was to assess the effect of parenteral iron administration on biomarkers of mineral and bone homeostasis over time. Materials and methods: The study was a single-centre non-randomised prospective study. It was carried out between 2016 and 2020 in a group of patients in the Department of Internal Medicine and Gastroenterology Subunit of Inflammatory Bowel Diseases at the National Institute of Medicine of the Ministry of the Interior and Administration in Warsaw. At the first examination, the baseline disease severity, initial evaluation of anaemia (morphology, iron (Fe), total iron binding capacity (TIBC), ferritin, vitamin B12, folic acid) and bone mineral metabolism including C-reactive protein (CRP), albumins, alkaline phosphatase (ALP), Calcium, osteocalcin, phosphate in serum and in urine, parathyroid hormone (PTH), vitamin D3, fibroblast growth factor (iFGF23) and procollagen type 1N propeptide (P1NP) C-terminal telopeptide (CTX), was initially assessed. On the basis of peripheral blood counts, an appropriate dose of iron (iron derisomaltose or caboxymaltose) was administered. During the subsequent appointments on week 1, 4, and 12 morphology, iron (Fe), total iron binding capacity (TIBC), ferritin, vitamin B12, folic acid, C-reactive protein (CRP), albumins, alkaline phosphatase (ALP), Calcium, osteocalcin, phosphate in serum and in urine, parathyroid hormone (PTH), vitamin D3, fibroblast growth factor (iFGF23) and procollagen type 1N propeptide (P1NP) C-terminal telopeptide (CTX), were evaluated. Results: A total of 56 patients were enrolled into the study: 24 women and 32 men. In the group, 32 patients had Crohn’s disease (CD) and 24 had ulcerative colitis (UC). We found a statistically significant increase in the concentration of albumin (p = 0.031), haemoglobin (p < 0.001), haematocrit (p < 0.001), MCV (p < 0.001), MCHC (p = 0.001), iron (p < 0.001) and ferritin (p < 0.001) after the administration of parenteral iron. The influence of individual iron formulations on the analysed parameters (phosphate concentration in serum and in the urine, iFGF23, P1NP, PTH, vitamin D, haemoglobin and ferritin) was similar. Interestingly, an inverse correlation was found between the concentration of phosphorus in the blood and iFGF23 at certain time-points; however, in the study group they did not significantly affect the disturbances of calcium and phosphate metabolism. Conclusions: In the study group, transient and non-significant disorders of phosphate metabolism were found, which does not constitute a contraindication to treatment with parenteral iron in inflammatory bowel disease patients, which was safe and efficient.
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Affiliation(s)
- Edyta Tulewicz-Marti
- Clinical Department of Internal Medicine and Gastroenterology with Inflammatory Bowel Disease Subunit, National Medical Institute of the Ministry of the Interior and Administration, 02-507 Warsaw, Poland
- Correspondence:
| | - Paulina Szwarc
- Clinical Department of Internal Medicine and Gastroenterology with Inflammatory Bowel Disease Subunit, National Medical Institute of the Ministry of the Interior and Administration, 02-507 Warsaw, Poland
| | - Martyna Więcek
- Clinical Department of Internal Medicine and Gastroenterology with Inflammatory Bowel Disease Subunit, National Medical Institute of the Ministry of the Interior and Administration, 02-507 Warsaw, Poland
| | - Konrad Lewandowski
- Clinical Department of Internal Medicine and Gastroenterology with Inflammatory Bowel Disease Subunit, National Medical Institute of the Ministry of the Interior and Administration, 02-507 Warsaw, Poland
| | - Tomasz Korcz
- Laboratory Diagnostics Department, National Medical Institute of the Ministry of the Interior and Administration, 02-507 Warsaw, Poland
| | - Malgorzata Cicha
- Laboratory Diagnostics Department, National Medical Institute of the Ministry of the Interior and Administration, 02-507 Warsaw, Poland
| | - G. Rydzewska
- Clinical Department of Internal Medicine and Gastroenterology with Inflammatory Bowel Disease Subunit, National Medical Institute of the Ministry of the Interior and Administration, 02-507 Warsaw, Poland
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland
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10
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Scholz KAM, Thomann AK, Teich N, Baumann H, Walldorf J, Büning C, Rosania R, Canbay A, Arnim UV. Validation of the German Inflammatory Bowel Disease Fatigue (IBD-F) Questionnaire. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2023; 61:164-171. [PMID: 35533686 DOI: 10.1055/a-1797-2688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Fatigue is a common symptom in patients with inflammatory bowel diseases (IBD). To date, there is no instrument to assess IBD-specific fatigue in German. The aim of this study was to translate the IBD Fatigue (IBD-F) scale and to test its psychometric properties in a German IBD population. METHODS After completing the translation process, 20 IBD patients participated in a pilot testing phase. For further analyses, 180 IBD patients with fatigue answered the IBD-F (Sections I, II, III) and the IBD Questionnaire (IBDQ-D). Reliability was tested by using Cronbach's alpha and corrected item-total correlation. Exploratory factor analyses (EFA) were carried out. Spearman's correlation was calculated between the IBD-F and IBDQ-D . 78 patients could be included to calculate the test-retest reliability. RESULTS The German version of the IBD-F shows high face and content validity. Internal consistency was excellent, with a Cronbach's alpha of 0.93-0.98. Corrected item-total correlations ranged from 0.51 to 0.89. The correlation between the IBD-F and the IBDQ-D was statistically significant for Section I (rs=-0.59; p<0.01) and Section II (rs=-0.76; p<0.01) of the IBD-F. The EFA identified one relevant factor for each section. Test-retest reliability was acceptable for Section I (intraclass correlation coefficient (ICC)=0.73) and Section II (ICC=0.84). CONCLUSION The German version of the IBD-F is a reliable and valid tool to assess fatigue in IBD.
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Affiliation(s)
| | - Anne Kerstin Thomann
- Department of Medicine II, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Niels Teich
- Internal medicine practice for Digestive and Metabolic Diseases, Leipzig, Germany
| | - Hartmut Baumann
- Gastroenterological practice Gardelegen, Gardelegen, Germany
| | - Jens Walldorf
- Department of Internal Medicine I, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
| | - Carsten Büning
- Department of Internal Medicine, Hospital Waldfriede, Berlin-Zehlendorf, Germany
| | - Rosa Rosania
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Magdeburg, Magdeburg, Germany
| | - Ali Canbay
- Department of Medicine, Knappschaftskrankenhaus, Ruhr University Bochum, Bochum, Germany
| | - Ulrike von Arnim
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Magdeburg, Magdeburg, Germany
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11
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Christensen KR, Ainsworth MA, Steenholdt C, Buhl S, Skougaard M, Brynskov J, Jørgensen TS, Kristensen LE. Fatigue is a systemic extraintestinal disease manifestation largely independent of disease activity, chronicity, and nutritional deficiencies in inflammatory bowel disease on biologics. Scand J Gastroenterol 2022; 57:1051-1057. [PMID: 35412932 DOI: 10.1080/00365521.2022.2060049] [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] [Indexed: 02/04/2023]
Abstract
BACKGROUND Fatigue is a common symptom reported by patients with chronic immunoinflammatory diseases and with profound negative implications on health-related quality of life. This study aimed to delineate underlying components contributing to fatigue in patients with inflammatory bowel disease (IBD) receiving biologic therapy. METHODS Cross-sectional questionnaire study of all patients with IBD receiving any biologic therapy at a tertiary IBD center. Fatigue was assessed by Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F). Disease activity and quality of life were evaluated by generic questionnaires. Principal component analysis (PCA) was used to identify components of variables explaining fatigue. RESULTS Three hundred patients with IBD were included. Moderate-to-severe fatigue defined as FACIT-F ≤ 39 was present in half of the included patients. PCA condensed variables associated with fatigue into three main components contributing to 49% of observed fatigue. The first component, explaining 21% of fatigue, included factors related to disease chronicity, e.g., long disease duration, high number of previously used biologic therapies, presence of previous intestinal surgery, and increasing age. The second component explained 14% of fatigue and comprised disease activity-related aspects, e.g., disease activity indices and C-reactive protein. The third explained 14% of fatigue and comprised various nutritional deficiencies. CONCLUSION Fatigue can partly be explained by chronicity, disease activity, and nutritional deficits. However, the cause of fatigue is unexplained in approximately half of the patients with IBD supporting that fatigue can be an independent, systemic extraintestinal disease manifestation in IBD.
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Affiliation(s)
- Katrine Risager Christensen
- Department of Gastroenterology, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark.,The Parker Institute, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | | | - Casper Steenholdt
- Department of Gastroenterology, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark
| | - Sine Buhl
- Department of Gastroenterology, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark
| | - Marie Skougaard
- The Parker Institute, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Jørn Brynskov
- Department of Gastroenterology, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark
| | - Tanja Schjødt Jørgensen
- The Parker Institute, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Lars Erik Kristensen
- The Parker Institute, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
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12
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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] [Key Words] [MESH Headings] [Grants] [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.
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Affiliation(s)
- Feng Xu
- Affiliated Hospital of Nanjing University of Chinese Medicine (Jiangsu Province Hospital of Chinese Medicine), Nanjing, 210029, Jiangsu Province, China
| | - Jingyi Hu
- Affiliated Hospital of Nanjing University of Chinese Medicine (Jiangsu Province Hospital of Chinese Medicine), Nanjing, 210029, Jiangsu Province, China
| | - Qian Yang
- Affiliated Hospital of Nanjing University of Chinese Medicine (Jiangsu Province Hospital of Chinese Medicine), Nanjing, 210029, Jiangsu Province, China
| | - Yuejin Ji
- Affiliated Hospital of Nanjing University of Chinese Medicine (Jiangsu Province Hospital of Chinese Medicine), Nanjing, 210029, Jiangsu Province, China
| | - Cheng Cheng
- Affiliated Hospital of Nanjing University of Chinese Medicine (Jiangsu Province Hospital of Chinese Medicine), Nanjing, 210029, Jiangsu Province, China
| | - Lei Zhu
- Affiliated Hospital of Nanjing University of Chinese Medicine (Jiangsu Province Hospital of Chinese Medicine), Nanjing, 210029, Jiangsu Province, China.
| | - Hong Shen
- Affiliated Hospital of Nanjing University of Chinese Medicine (Jiangsu Province Hospital of Chinese Medicine), Nanjing, 210029, Jiangsu Province, China.
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13
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D'Silva A, Fox DE, Nasser Y, Vallance JK, Quinn RR, Ronksley PE, Raman M. Prevalence and Risk Factors for Fatigue in Adults With Inflammatory Bowel Disease: A Systematic Review With Meta-Analysis. Clin Gastroenterol Hepatol 2022; 20:995-1009.e7. [PMID: 34216824 DOI: 10.1016/j.cgh.2021.06.034] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 06/10/2021] [Accepted: 06/18/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Inflammatory bowel disease (IBD) is a chronic relapsing and remitting disease with high morbidity, substantial health care costs, and increasing incidence. Fatigue is one of the most common symptoms that impacts quality of life and is a leading concern for patients with IBD. The aim of this study was to determine the global prevalence, risk factors, and impact of fatigue in adults with IBD. METHODS A systematic review and meta-analysis was conducted. Data were retrieved from Medline, Embase, CINAHL, and PsycINFO from database inception to October 2019. A pooled prevalence of fatigue was calculated using a random-effects model. Stratified meta-analyses explored sources of between-study heterogeneity. Study quality was assessed using an adapted checklist from Downs and Black. RESULTS The search yielded 4524 studies, of which 20 studies were included in the systematic review and meta-analysis. Overall, the studies were of good quality. The pooled prevalence of fatigue was 47% (95% confidence interval, 41%-54%), though between-study heterogeneity was high (I2 = 98%). Fatigue prevalence varied significantly by the definition of fatigue (chronic: 28%; high: 48%; P < .01) and disease status (active disease: 72%; remission: 47%; P < .01). Sleep disturbance, anxiety, depression, and anemia were the most commonly reported fatigue-related risk factors. CONCLUSIONS The prevalence of fatigue in adults with IBD is high, emphasizing the importance of additional efforts to manage fatigue to improve the care and quality of life for patients with IBD.
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Affiliation(s)
- Adrijana D'Silva
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Danielle E Fox
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Yasmin Nasser
- Snyder Institute of Chronic Disease, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jeff K Vallance
- Faculty of Health Disciplines, Athabasca University, Alberta, Canada
| | - Robert R Quinn
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Division of Nephrology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Paul E Ronksley
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Maitreyi Raman
- Division of Gastroenterology and Hepatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
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14
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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: 3] [Impact Index Per Article: 1.5] [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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15
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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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16
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Ballesio A, Zagaria A, Baccini F, Micheli F, Di Nardo G, Lombardo C. A meta-analysis on sleep quality in inflammatory bowel disease. Sleep Med Rev 2021; 60:101518. [PMID: 34214847 DOI: 10.1016/j.smrv.2021.101518] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 06/08/2021] [Accepted: 06/09/2021] [Indexed: 12/12/2022]
Abstract
Evidence of poor sleep quality in inflammatory bowel disease (IBD, i.e., Crohn's disease and ulcerative colitis) has been reported but never systematically reviewed or meta-analysed. We conducted a systematic review and meta-analysis of pairwise comparisons that included 1) IBD patients/controls, 2) Crohn's disease/ulcerative colitis, 3) active/inactive IBD on standardised measures of sleep quality. PubMed, Medline, PsycINFO, Scopus, and CINAHL were searched up to March 2021. Forty-two studies met the inclusion criteria. Results showed poorer subjective sleep quality in IBD patients than in controls, with moderate effect sizes (g = .49, [95% CI = .32 - .66], p < .001). No differences within IBD subtypes were found (g = -.07, [95% CI = -.17-.05], p = .208). Individuals with an active IBD reported poorer sleep quality than those in remission, with a large effect size (g = .66, [95% CI = .35 - .98], p < .001). Results on objectively recorded sleep were mixed, with no clear evidence of objective sleep impairments in individuals with IBD. Results support the view of subjective poor sleep quality as a relevant comorbidity in IBD. As a potential factor affecting immune and inflammatory responses as well as patients' quality of life, sleep quality should be taken into account in the treatment of IBD.
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Affiliation(s)
- Andrea Ballesio
- Department of Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy.
| | - Andrea Zagaria
- Department of Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Flavia Baccini
- Department of Medical-Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Italy
| | - Federica Micheli
- Department of Medical-Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Italy
| | - Giovanni Di Nardo
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Italy
| | - Caterina Lombardo
- Department of Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
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Sarcopenia and Vitamin D Deficiency in Patients with Crohn's Disease: Pathological Conditions That Should Be Linked Together. Nutrients 2021; 13:nu13041378. [PMID: 33923948 PMCID: PMC8074054 DOI: 10.3390/nu13041378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/16/2021] [Accepted: 04/17/2021] [Indexed: 12/16/2022] Open
Abstract
Sarcopenia is a prevalent condition in patients with Crohn’s disease (CD), representing an independent predictor factor for the development of major postoperative complications. Thus, a proper assessment of the muscle strength, by using different validated tools, should be deemed an important step of the clinical management of these patients. Patients with CD are frequently malnourished, presenting a high prevalence of different macro- and micro-nutrient deficiencies, including that of vitamin D. The available published studies indicate that vitamin D is involved in the regulation of proliferation, differentiation, and regeneration of muscle cells. The relationship between vitamin D deficiency and sarcopenia has been extensively studied in other populations, with interesting evidence in regards to a potential role of vitamin D supplementation as a means to prevent and treat sarcopenia. The aim of this review was to find studies that linked together these pathological conditions.
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18
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Papanikolaou IC, Afthinos A, Patsiris S, Pagratis K. Fatigue and Vitamin D in Sarcoidosis: A Prospective Non-Interventional Study. Am J Med Sci 2020; 361:553-555. [PMID: 33190856 DOI: 10.1016/j.amjms.2020.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 09/17/2020] [Accepted: 10/02/2020] [Indexed: 11/16/2022]
Affiliation(s)
| | - Andreas Afthinos
- Pulmonary Department, General Hospital of Corfu, Corfu Town, Greece
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19
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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.
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20
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Jelsness-Jørgensen LP, Grøvle L, Julsrud Haugen A. Association between vitamin D and fatigue in patients with rheumatoid arthritis: a cross-sectional study. BMJ Open 2020; 10:e034935. [PMID: 32034029 PMCID: PMC7044854 DOI: 10.1136/bmjopen-2019-034935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES In rheumatoid arthritis (RA), fatigue is an important complaint with a significant impact on quality of life. Vitamin D has modulatory effects on cells of the immune system and may potentially affect RA disease activity and thereby RA-related fatigue. The purpose of this study was to explore associations between fatigue and vitamin D status in patients with RA. DESIGN Hypothesis-generating cross-sectional study. SETTING Scheduled follow-up visits at a hospital-based general rheumatology clinic. PARTICIPANTS Patients (n=169) with established RA. PRIMARY OUTCOME MEASURES AND ANLYSES Fatigue, assessed by the Chalder fatigue questionnaire, and serum concentrations of 25-hydroxyvitamin D (25(OH)D), assessed by liquid chromatography-tandem mass spectrometry. Associations were analysed by correlation, and multivariate linear regression with adjustments for age, sex, body mass index, RA disease activity as measured by the Disease Activity Score 28-joint count C reactive protein (DAS28-CRP), psychological distress, pain and sleep. Fatigue was also compared across four groups based on the levels of serum 25(OH)D with cut points at 30, 50 and 75 nmol/L using one-way analysis of variance. RESULTS Two-thirds of the patients (116/169, 69%) were classified with low RA disease activity, that is, a DAS28-CRP score below 3.2. Their mean (SD) serum 25(OH)D concentration was 56.3 (21.2) nmol/L, with 77 (45.6%) having values below 50 nmol/L and 12 patients (7.1%) below 30 nmol/L. The correlation between fatigue and serum concentrations of 25(OH)D was weak and not statistically significant, r = -0.14 (95% CI: -0.29 to 0.03, p=0.08). In the multivariate model, fatigue was significantly associated with RA disease activity, psychological distress and pain, but not with serum 25(OH)D. Fatigue did not differ across groups with varying levels of serum 25(OH)D. CONCLUSION This cross-sectional study found no evidence of association between vitamin D and fatigue in patients with RA.
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Affiliation(s)
- Lars Petter Jelsness-Jørgensen
- Internal Medicine, Sykehuset Ostfold HF, Sarpsborg, Norway
- Health Sciences, Østfold University College, Fredrikstad, Norway
| | - Lars Grøvle
- Rheumatology, Sykehuset Ostfold HF, Sarpsborg, Norway
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21
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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: 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.
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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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22
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Olmedo-Martín RV, González-Molero I, Olveira G, Amo-Trillo V, Jiménez-Pérez M. Vitamin D in Inflammatory Bowel Disease: Biological, Clinical and Therapeutic Aspects. Curr Drug Metab 2019; 20:390-398. [PMID: 31109269 DOI: 10.2174/1389200220666190520112003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 04/13/2019] [Accepted: 04/25/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Vitamin D has an immunoregulatory action in Inflammatory Bowel Disease (IBD) as well as other immune-mediated disorders. Its influence on intestinal permeability, innate and adaptive immunity, and the composition and diversity of the microbiota contribute to the maintenance of intestinal homeostasis. Patients with IBD have a greater prevalence of vitamin D deficiency than the general population, and a possible association between this deficit and a worse course of the disease. However, intervention studies in patients with IBD have proved inconclusive. OBJECTIVE To review all the evidence concerning the role of vitamin D as an important factor in the pathophysiology of IBD, review the associations found between its deficiency and the prognosis of the disease, and draw conclusions for the practical application from the main intervention studies undertaken. METHODS Structured search and review of basic, epidemiological, clinical and intervention studies evaluating the influence of vitamin D in IBD, following the basic principles of scientific data. RESULTS Vitamin D deficiency is associated with disease activity, quality of life, the consumption of social and healthcare resources, and the durability of anti-TNFα biological treatment. Determination of new metabolites of vitamin D, measurement of its absorption capacity and questionnaires about sun exposure could help identify groups of IBD patients with a special risk of vitamin D deficiency. CONCLUSION Well-designed intervention studies are needed in IBD, with probably higher objective plasma doses of vitamin D to establish its efficacy as a therapeutic agent with immunomodulatory properties. Meanwhile, vitamin D deficiency should be screened for and corrected in affected patients in order to achieve adequate bone and phosphocalcic metabolism.
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Affiliation(s)
- Raúl Vicente Olmedo-Martín
- Clinical Management Unit of Digestive Diseases, Regional University Hospital of Malaga, Malaga, Spain; Faculty of Medicine, University of Malaga, Malaga, Spain.,Institute of Biomedical Research in Malaga (IBIMA), Malaga, Spain
| | - Inmaculada González-Molero
- Clinical Management Unit of Endocrinology and Nutrition, Regional University Hospital of Malaga; Institute of Biomedical Research in Malaga (IBIMA), Malaga, Spain; Faculty of Medicine, University of Malaga; CIBERDEM, Malaga, Spain
| | - Gabriel Olveira
- Clinical Management Unit of Endocrinology and Nutrition, Regional University Hospital of Malaga; Institute of Biomedical Research in Malaga (IBIMA), Malaga, Spain; Faculty of Medicine, University of Malaga; CIBERDEM, Malaga, Spain
| | - Víctor Amo-Trillo
- Clinical Management Unit of Digestive Diseases, Regional University Hospital of Malaga, Malaga, Spain; Faculty of Medicine, University of Malaga, Malaga, Spain.,Institute of Biomedical Research in Malaga (IBIMA), Malaga, Spain
| | - Miguel Jiménez-Pérez
- Clinical Management Unit of Digestive Diseases, Regional University Hospital of Malaga, Malaga, Spain; Faculty of Medicine, University of Malaga, Malaga, Spain.,Institute of Biomedical Research in Malaga (IBIMA), Malaga, Spain
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23
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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.
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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
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24
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Anti-Inflammatory Diets and Fatigue. Nutrients 2019; 11:nu11102315. [PMID: 31574939 PMCID: PMC6835556 DOI: 10.3390/nu11102315] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 09/12/2019] [Accepted: 09/25/2019] [Indexed: 12/12/2022] Open
Abstract
Accumulating data indicates a link between a pro-inflammatory status and occurrence of chronic disease-related fatigue. The questions are whether the observed inflammatory profile can be (a) improved by anti-inflammatory diets, and (b) if this improvement can in turn be translated into a significant fatigue reduction. The aim of this narrative review was to investigate the effect of anti-inflammatory nutrients, foods, and diets on inflammatory markers and fatigue in various patient populations. Next to observational and epidemiological studies, a total of 21 human trials have been evaluated in this work. Current available research is indicative, rather than evident, regarding the effectiveness of individuals’ use of single nutrients with anti-inflammatory and fatigue-reducing effects. In contrast, clinical studies demonstrate that a balanced diet with whole grains high in fibers, polyphenol-rich vegetables, and omega-3 fatty acid-rich foods might be able to improve disease-related fatigue symptoms. Nonetheless, further research is needed to clarify conflicting results in the literature and substantiate the promising results from human trials on fatigue.
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25
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Chen C, Luo Y, Su Y, Teng L. The vitamin D receptor (VDR) protects pancreatic beta cells against Forkhead box class O1 (FOXO1)-induced mitochondrial dysfunction and cell apoptosis. Biomed Pharmacother 2019; 117:109170. [DOI: 10.1016/j.biopha.2019.109170] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 06/24/2019] [Accepted: 06/25/2019] [Indexed: 01/15/2023] Open
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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: 128] [Impact Index Per Article: 25.6] [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.
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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
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27
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Jelsness-Jørgensen LP, Bernklev T, Lundin KEA. Fatigue as an Extra-Intestinal Manifestation of Celiac Disease: A Systematic Review. Nutrients 2018; 10:nu10111652. [PMID: 30400298 PMCID: PMC6266448 DOI: 10.3390/nu10111652] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 10/24/2018] [Accepted: 10/26/2018] [Indexed: 12/30/2022] Open
Abstract
Celiac disease may present with a range of different symptoms, including abdominal problems in a broader sense, iron deficiency and “constant tiredness”. All of these symptoms should consequently lead the clinicians to consider celiac disease as a potential etiopathogenetic cause. Although the pathophysiology of celiac disease is well documented, the actual mechanisms for disease presentation(s) are less well understood. We here address the topic of fatigue in celiac disease. A systematic literature search identified 298 papers of which five met the criteria for full evaluation. None of the reviewed papers were of high quality and had several methodological weaknesses. We conclude that there is an unmet need to study the contributing factors and management of fatigue in celiac disease.
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Affiliation(s)
- Lars-Petter Jelsness-Jørgensen
- Department of Health Science, Østfold University College, N-1757 Halden, Norway.
- Department of Gastroenterology, Østfold Hospital Trust Kalnes, N-1714 Grålum, Norway.
| | - Tomm Bernklev
- Department of Research and Innovation, Vestfold Hospital Trust, N-3103 Tønsberg, Norway.
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, N-0318 Oslo, Norway.
| | - Knut E A Lundin
- K.G. Jebsen Coeliac Disease Research Centre, University of Oslo, N-0318 Oslo, Norway.
- Department of gastroenterology, Oslo University Hospital Rikshospitalet, N-0372 Oslo, Norway.
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