Microbial dysbiosis may cause fatigue in patients with IBD

SAN DIEGO — Fatigue in patients with quiescent inflammatory bowel disease could be coming from a dysbiosis in the gut microbiome, according to study results presented at Digestive Disease Week.

“Fatigue remains persistent in 40% of the IBD population in remission in absence of any contributing factor,” Nienke Z. Borren, MD, of the division of gastroenterology at Massachusetts General Hospital, said in her presentation. “The etiology remains unexplained, which impairs our ability to effectively treat fatigue.”

Researchers performed a prospective study comprising 50 patients (48% women; mean age, 45 years) with either Crohn’s disease or ulcerative colitis that was in clinical remission (Harvey Bradshaw Index 4 or Simple Clinical Colitis Activity Index 2) and a colonoscopy within 1 year that displayed endoscopic remission. They defined significant fatigue by a score of 43 on the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) score.

Investigators also collected stool samples and conducted shotgun metagenomic sequencing to explore the relationships between the gut microbiome and fatigue.

Borren and colleagues found that the mean FACIT-F score was lower in patients with significant fatigue (29 vs. 49; P < .001), and patients with fatigue reported lower scores on the short IBD questionnaire (49 vs. 63), as well as greater anxiety, depression and disturbed sleep t-scores compared with those without (P < .001).

The gut microbiomes of patients with fatigue were less diverse and had reduced levels of Faecalibacterium (P = .000189) and Ruminococcus (P = .000295) at the genus level. At the species level, patients with fatigue also had depleted Faecalibacterium prausnitzii (P = .000189) and Roseburia hominis (P = .00795), both producers of butyrate.

Borren said their findings could support therapies that target the gut microbiome to reduce fatigue in patients with IBD.

“This prospective cohort study provides evidence for fatigue in patients with quiescent IBD might be cause by microbial dysbiosis,” Borren concluded. “Patients with fatigue have a less diverse gut microbiome compared to non-fatigue IBD patients, especially butyrate producers.” – by Alex Young

Reference:

Borren, et al. Abstract 146. Presented at: Digestive Disease Week; May 18-21, 2019; San Diego.

Disclosures: Borren reports no relevant financial disclosures. Please see the meeting disclosure index for all other authors’ relevant financial disclosures.