Nearly two-thirds of patients with IBD are fatigued or extremely fatigued
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Key takeaways:
- Most patients with inflammatory bowel disease were fatigued (51.3%) or extremely fatigued (12.2%).
- Fatigue was associated with depression, diminished quality of life, female sex and younger age.
Fatigue is a “burdensome and highly prevalent” symptom of patients with active and inactive inflammatory bowel disease and is strongly associated with depression, researchers reported in BMC Gastroenterology.
“A lack of energy, the cardinal symptom of fatigue, is one of the most frequent symptoms in IBD,” Victoria Uhlir, of the department of internal medicine at Jena University Hospital, and colleagues wrote. “Although fatigue is highly relevant, it is not well understood by patients or practitioners, and it has received insufficient attention in previous years. ... In previous studies, fatigue has been associated with depression, pain, anxiety, low quality of life, psychological well-being, anemia and sex.”
In a cross-sectional, paper-based survey study, Uhlir and colleagues aimed to analyze the influence of disease activity and common complications on fatigue among 189 patients (59.8% Crohn’s disease, 40.2% ulcerative colitis) with IBD.
Participants were asked to complete five questionnaires, including the Hospital Anxiety and Depression Scale (HADS), Fatigue Assessment Scale (FAS), McGill Pain Questionnaire, IBD Questionnaire (IBDQ) and Global Assessment Scale.
According to results, mean FAS scores were 24.72 for patients with CD and 24.71 for patients with UC. Nearly two-thirds of patients were fatigued (51.3%) or extremely fatigued (12.2%), a finding “significantly more frequent” among women compared with men (80.9% vs. 48%).
Researchers also reported that fatigue was more often present among patients with moderate to severe disease activity (CD = 95.7%; UC = 75%) compared with those in remission (46.6% and 62.5%, respectively).
Data from HADS demonstrated that 83.8% of patients without fatigue had “unremarkable” anxiety symptoms while 60.9% of patients with extreme fatigue were anxious. Similarly, 95.6% of those without fatigue had no depressive symptoms while 43.5% of the extremely fatigued group had severe or very severe depression.
Most patients (84.4%) with low IBDQ scores (< 171) experienced fatigue or extreme fatigue, and 77.2% of patients with extreme fatigue reported “distressing or worse” intensity of pain.
Multivariate analysis also showed that fatigue was associated with female sex (P = .015), depression (P = .002) and quality of life (P = .015) in CD, as well as depression (P = .02) and younger age (P = .024) in UC. Researchers noted the influence of anemia or disease activity was nonsignificant.
“Fatigue is burdensome and highly prevalent in patients with IBD,” Uhlir and colleagues concluded. “Fatigue should receive attention in patients with active disease as well as disease in remission because it did not significantly correlate with anemia or disease activity.”
They continued: “The strong associations with depression highlight the importance of investigating and addressing possible underlying subclinical depression in patients reporting fatigue symptoms.”
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