Fatigue is a common symptom complaint among patients with Crohn’s disease and ulcerative colitis, but is poorly understood,” Miguel Regueiro, MD, explains. “My colleagues and I wanted to understand the prevalence of fatigue in our patients with IBD.”

Dr. Regueiro and colleagues describe fatigue as a lack of energy or “an overwhelming sense of tiredness” that limits
daily activities and is not alleviated by rest. Several factors have been shown to contribute to fatigue in IBD, including iron deficiency, low levels of serum vitamin D and magnesium, sleep disturbances, alcohol misuse, and emotional stress. However, “the underlying complexity of factors contributing to fatigue” have resulted in treatments that are often empirical, and resolution of symptoms is hard to attain, according to the study results. Additionally, while fatigue is a common complaint among patients with CD and UC, it often goes under-reported and untreated.\

For a study published in Advances in Therapy, Dr. Regueiro and colleagues distributed a cross-sectional survey to gastroenterologists and their adult patients with CD or UC. Gastroenterologists provided patient demographics, clinical characteristics, disease activity, and medication use, while patients described current symptoms, including fatigue, rectal urgency, abdominal pain, sleep disturbance, and work productivity; they also completed the Short Inflammatory Bowel Disease Questionnaire (SIBDQ). Logistic regression models identified measures associated with fatigue.

Pain, Sleep Issues & Work Impairment Higher With Fatigue

The researchers included 1,228 patients with CD and 1,057 patients with UC in the analysis. Mean patient age, distribution of women and men, and mean BMI were similar between groups.

Fatigue was slightly more common in patients with CD compared with UC (26.0% vs 22.6%). Overall, patients with fatigue had a higher mean pain level (P<0.0001), a higher mean level of sleep disturbances (P<0.0001), and overall work impairment (P=0.0170) than patients without fatigue.

Compared with those without fatigue, a greater proportion of patients with UC and fatigue had moderate/severe disease activity (P=0.0001), a higher Mayo score (P<0.0001), and were unemployed (P=0.0149). In CD, compared with those without fatigue, patients with fatigue were more often female (P=0.0193) and unemployed (P=0.0069),
with moderate/severe disease (P<0.0001) and a higher mean CD Activity Index score (P<0.0001).

“Although certain factors, such as anemia or vitamin deficiencies, may be causes of fatigue, we found that fatigue occurred independently of these factors,” Dr. Regueiro says.

For patients with CD, abdominal pain (P<0.001) and treatment with biologics or biosimilars (P=0.003) correlated with an increased likelihood of fatigue as reported by patients. Patients with lower SIBDQ (OR,0.54; P<0.001) and overall pain scores (OR, 0.82; P=0.003) were less likely to indicate fatigue.

Among patients with UC, abdominal pain and treatment with immunomodulators led to significantly greater odds of patients reporting fatigue (ORs, 2.01 and 1.70, respectively), while patients experiencing rectal bleeding had lower odds of reporting fatigue compared with those with “no blood seen” (P=0.024). For every unit increase in the
EQ-5D and SIBDQ score, patients were 0.12 times and 0.56 times less likely to report fatigue, respectively.

Clinicians Should Inquire About Fatigue in IBD

The findings show that “fatigue may be an extra-intestinal manifestation of IBD,” Dr. Regueiro says. The researchers also reported that fatigue was associated with poor QOL.

The different factors that drive fatigue in IBD indicate that a multidisciplinary approach may be necessary to manage it, according to the study results. Future research should examine the etiology of fatigue in IBD.

“We need to understand why fatigue occurs with IBD, but our results make it clear that we need to ask our patients about fatigue and incorporate fatigue scores into clinical trials,” Dr. Regueiro says. “In future studies, we will evaluate whether medications that are used to treat IBD can also improve fatigue.”