Issue 06

Clinical Question

In out-patients with inflammatory bowel diseases (IBD) that are in remission, what are the prevalence of fatigue and its predictors?

Editor’s Bottom Line

Most patients with IBD in remission experience fatigue, and this is most prevalent in women and those with concomitant depression/anxiety.

Reference

Villoria A, García V, Dosal A, et al. Fatigue in out-patients with inflammatory bowel disease: prevalence and predictive factors. PLoS One. 2017 Jul 27;12(7):e0181435. https://www.ncbi.nlm.nih.gov/pubmed/28749985

Synopsis

Patients with IBD in remission for a minimum of 3 months and taking either immunosuppressants or biologics were recruited into the study. Apart from demographics and medical/drug history, patients provided a blood sample for routine biochemical and hematological testing as well as for measurement of micronutrients and interleukins (IL). Validated Spanish language surveys completed were: Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Epworth Sleepiness Scale (ESS), and the Quality of Life in IBD (IBDQ-9).

The enrolled 177 patients (CD=127, UC=50; M:F, 10:7) had a mean age of 39 years (SD±12) and mean BMI of 25 kg/m² (SD±4.4), and had been diagnosed with IBD for a mean of 9 years (SD±6). Medication used was: infliximab 25%, adalimumab 15%, thiopurines 78%, methotrexate 7%, and 5-ASA, 16%. Ninety-six patients (54%) had fatigue (severe, 11%; mild 43%). On multivariate analysis, predictors of increased fatigue were female sex (Odds Ratio 4.8), high BMI (OR 1.2), and higher BDI score for depression (OR 1.2). IBDQ-9 scores decreased with increasing fatigue. Medications, subtype of IBD, joint pain, IBD-related surgery, or blood measures were unrelated to fatigue. The four surveys (BDI, STAI, ESS, IBDQ-9) were robustly correlated with fatigue severity highlighting the interplay of depression and anxiety with physical health.

Details

Study Design: Prospective observational cohort study
Funding: Fundacio Parc Tauli #2013043
Allocation: n/a
Setting: Single centre, Spain
Level of Evidence: 1b (Oxford Levels of Evidence)

The summary and conclusion in this issue of E-mentoring in IBD pertains to the manuscript(s) being reviewed, and should be considered in the context of what is already known surrounding the topic and incorporated into practice as deemed appropriate by the individual learner.