Issue 12

Clinical Question

For patients with longstanding IBD (>20 years), do their high levels of fatigue and rates of chronic fatigue ever re-align with those reported by the general population?

Editor’s Bottom Line

After 20 years of living with IBD, patients continue to experience higher rates of fatigue and chronic fatigue relative to the general population.

Reference

Huppertz-Hauss G, Høivik ML, Jelsness-Jørgensen LP, et al. Fatigue in a population-based cohort of patients with inflammatory bowel disease 20 years after diagnosis: The IBSEN study. Scand J Gastroenterol. 2017 Mar;52(3):351–58. https://www.ncbi.nlm.nih.gov/pubmed/27852169

Synopsis

From 1990–1993, all newly diagnosed IBD patients were included in an inception cohort and followed for 20 years. Patients from this cohort were invited to participate in the fatigue study. Patients completed the Fatigue Questionnaire, Hospital Anxiety and Depression Scale, IBDQ (Norwegian), and had hemoglobin, fecal calprotectin, C-reactive protein measures determined and a medical chart review.

The invited cohort (CD 146, UC 314) was diagnosed with IBD at a median age of 33 years (M:F 1:1). Of these patients, 73.5% (n=440) completed the fatigue questionnaire. The mean fatigue scores for CD (14.4) and UC (13.5) were significantly higher than the Norwegian reference population (12.2; P<0.001 vs. CD and UC). Chronic fatigue rates of 25.4% in CD and 20.8% in UC were also higher than 11% reported for general population (P<0.001 vs. CD and UC). Compared to male IBD patients, female patients had significantly higher fatigue scores (14.8 vs. 12.8, P<0.001) and rates of chronic fatigue (27.9% vs. 16.6%, P=0.005).

Fatigue scores in patients with quiescent disease was similar to the reference population. Fatigue scores in those with active disease were higher, especially when active symptoms were present. Chronic fatigue was more frequent in IBD patients than the reference population.

Factors associated with fatigue in the IBD patients were disease symptoms, poor sleep quality, anxiety and depression.

Details

Study Design: Prospective observational cohort study
Funding: Public Regional Health Trust, Norway
Allocation: n/a
Setting: Parent inception cohort study
Level of Evidence: 2b (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.